1
|
Van Herreweghe I, De Fré O, Polus F, Cops J, López AM, Vandepitte C, Van Boxstael S, Van Poucke S, Mesotten D, Hadzic A. Spinal anesthesia in patients with aortic stenosis: a research report. Reg Anesth Pain Med 2024:rapm-2023-105113. [PMID: 38267077 DOI: 10.1136/rapm-2023-105113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Affiliation(s)
| | | | | | | | - Ana M López
- Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Sam Van Boxstael
- Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences & Limburg Clinical Research Center, UHasselt, Diepenbeek, Belgium
| | | | | | - Admir Hadzic
- Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology & Algology, Faculty of Medicine, KU Leuven, Leuven, Flanders, Belgium
| |
Collapse
|
2
|
Gautier N, Lejeune D, Al Zein L, Kesteloot C, Ciccarella Y, Brichant JF, Bouvet L, Cops J, Hadzic A, Gautier PE. The effects of intrathecal morphine on urinary bladder function and recovery in patients having a cesarean delivery - A randomized clinical trial. Anaesth Crit Care Pain Med 2023; 42:101269. [PMID: 37364852 DOI: 10.1016/j.accpm.2023.101269] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Spinal anesthesia with intrathecal morphine (ITM) is a common anesthesia technique for cesarean delivery. The hypothesis was that the addition of ITM will delay micturition in women undergoing cesarean delivery. METHODS Fifty-six ASA physical status I and II women scheduled to undergo elective cesarean delivery under spinal anesthesia were randomized to the PSM group (50 mg prilocaine + 2.5 mcg sufentanil + 100 mcg morphine; n = 30) or PS group (50 mg prilocaine + 2.5 mcg sufentanil; n = 24). The patients in the PS group received a bilateral transverse abdominal plane (TAP) block. The primary outcome was the effect of ITM on the time to micturition and the secondary outcome was the need for bladder re-catheterization. RESULTS The time to first urge to urinate (8 [6-10] hours in the PSM group versus 6 [4-6] hours in the PS group) and the time to first micturition (10 [8-12] hours in the PSM group versus 6 [6-8] hours in the PS group) were significantly (p < 0.001) prolonged in the PSM group. Two patients in the PSM group met the 800 mL criterium for urinary catheterization after 6 and 8 h respectively. CONCLUSION This study is the first randomized trial to demonstrate that the addition of ITM to the standardized mixture of prilocaine and sufentanil significantly delayed micturition.
Collapse
Affiliation(s)
- Nicolas Gautier
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Delphine Lejeune
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Lilas Al Zein
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Cédric Kesteloot
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Yannick Ciccarella
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Jean-François Brichant
- Department of Anesthesiology and Resuscitation, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Lionel Bouvet
- Department of Anesthesia and Critical Care, Hospices Civils de Lyon, Lyon, France
| | | | - Admir Hadzic
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology & Algology, Faculty of Medicine, KULeuven, Leuven, Belgium
| | - Philippe E Gautier
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| |
Collapse
|
3
|
Van Boxstael S, Peene L, Dylst D, Penders J, Hadzic A, Meex I, Corten K, Mesotten D, Thiessen S. The effect of spinal versus general anaesthesia on perioperative muscle weakness in patients having bilateral total hip arthroplasty: a single center randomized clinical trial. Eur J Med Res 2023; 28:450. [PMID: 37864209 PMCID: PMC10588152 DOI: 10.1186/s40001-023-01435-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/07/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Perioperative neuro-endocrine stress response may contribute to acquired muscle weakness. Regional anaesthesia has been reported to improve the outcome of patients having total hip arthroplasty. In this study, it was hypothesized that spinal anaesthesia (SA) decreases the perioperative neuro-endocrine stress response and perioperatively acquired muscle weakness (PAMW), as compared to general anaesthesia (GA). METHODS Fifty subjects undergoing bilateral total hip arthroplasty (THA) were randomly allocated to receive a standardized SA (n = 25) or GA (n = 25). Handgrip strength was assessed preoperatively, on the first postoperative day (primary endpoint) and on day 7 and 28. Respiratory muscle strength was measured by maximal inspiratory pressure (MIP). Stress response was assessed by measuring levels of Adrenocorticotropic hormone (ACTH), cortisol and interleukin-6 (IL-6). RESULTS Handgrip strength postoperatively (day 1) decreased by 5.4 ± 15.9% in the SA group, versus 15.2 ± 11.7% in the GA group (p = 0.02). The handgrip strength returned to baseline at day 7 and did not differ between groups at day 28. MIP increased postoperatively in patients randomized to SA by 11.7 ± 48.3%, whereas it decreased in GA by 12.2 ± 19.9% (p = 0.04). On day 7, MIP increased in both groups, but more in the SA (49.0 ± 47.8%) than in the GA group (14.2 ± 32.1%) (p = 0.006). Postoperatively, the levels of ACTH, cortisol and IL-6 increased in the GA, but not in the SA group (p < 0.004). CONCLUSION In patients having bilateral THA, SA preserved the postoperative respiratory and peripheral muscle strength and attenuated the neuro-endocrine and inflammatory responses. TRIAL REGISTRATION clinicaltrials.gov NCT03600454.
Collapse
Affiliation(s)
- Sam Van Boxstael
- Critical Care Department, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
- Faculty of Medicine and Life Sciences & Limburg Clinical Research Center, UHasselt, Diepenbeek, Belgium.
| | - Laurens Peene
- Critical Care Department, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Dimitri Dylst
- Critical Care Department, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Joris Penders
- Laboratory of Clinical Biology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Admir Hadzic
- Critical Care Department, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Ingrid Meex
- Critical Care Department, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Kristoff Corten
- Department of Orthopaedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Dieter Mesotten
- Critical Care Department, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
- Faculty of Medicine and Life Sciences & Limburg Clinical Research Center, UHasselt, Diepenbeek, Belgium
| | - Steven Thiessen
- Critical Care Department, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| |
Collapse
|
4
|
Lam KHS, Wu YT, Reeves KD, Hadzic A, Perez MF, Fu SN. A novel infrapatellar approach of ultrasound-guided intra-articular injection of the knee from both lateral and medial side: a case series. Ther Adv Musculoskelet Dis 2023; 15:1759720X221149954. [PMID: 36793993 PMCID: PMC9923012 DOI: 10.1177/1759720x221149954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/21/2022] [Indexed: 02/01/2023] Open
Abstract
Knee osteoarthritis (OA) is common. Ultrasound-guided intra-articular injection (UGIAI) using the superolateral approach is currently the gold standard for treating knee OA, but it is not 100% accurate, especially in patients with no knee effusion. Herein, we present a case series of chronic knee OA treated with a novel infrapatellar approach to UGIAI. Five patients with chronic grade 2-3 knee OA, who had failed on conservative treatments and had no effusion but presented with osteochondral lesions over the femoral condyle, were treated with UGIAI with different injectates using the novel infrapatellar approach. The first patient was initially treated using the traditional superolateral approach, but the injectate was not delivered intra-articularly and became trapped in the pre-femoral fat pad. The trapped injectate was aspirated in the same session due to interference with knee extension, and the injection was repeated using the novel infrapatellar approach. All patients who received the UGIAI using the infrapatellar approach had the injectates successfully delivered intra-articularly, as confirmed with dynamic ultrasound scanning. Their Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and function scores significantly improved 1 and 4 weeks post-injection. UGIAI of the knee using a novel infrapatellar approach is readily learned and may improve accuracy of UGIAI, even for patients with no effusion.
Collapse
Affiliation(s)
| | - Yung-Tsan Wu
- Department of Physical Medicine and
Rehabilitation, Tri-Service General Hospital, School of Medicine, National
Defense Medical Center, Taipei, Taiwan,Integrated Pain Management Center, Tri-Service
General Hospital, School of Medicine, National Defense Medical Center,
Taipei, Taiwan,Department of Research and Development, School
of Medicine, National Defense Medical Center, Taipei, Taiwan
| | | | | | - Mario Fajardo Perez
- Ultradissection Group, Madrid, Spain,MOMARC, Madrid, Spain,Vithas Hospital, Madrid, Spain
| | - Sau Nga Fu
- Department of Family Medicine, The Chinese
University of Hong Kong, Shatin, Hong Kong,Department of Family Medicine, The University
of Hong Kong, Pokfulam, Hong Kong
| |
Collapse
|
5
|
Van Herreweghe I, Caekebeke P, Balocco AL, Van Boxstael S, Hadzic A. Motor-Sparing Nerve Blocks Can Improve the Results of Digit Tendon Surgery: A Case Report. A A Pract 2022; 16:e01567. [PMID: 35171841 DOI: 10.1213/xaa.0000000000001567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 56-year-old woman presented with flexion dysfunction of the fifth digit 6 weeks after surgical repair of a flexor digitorum profundus laceration. She was scheduled for surgical adhesiolysis and restoration of the functionality of the finger. Intraoperative monitoring of the range of motion by active flexion was deemed important to prevent incomplete release of the tendon and residual dysfunction. Distal median and ulnar nerve blocks were used for anesthesia with the patient's ability to flex the finger. This case suggests that motor-sparing peripheral nerve blocks can improve functional outcome in certain hand surgeries.
Collapse
Affiliation(s)
| | - Pieter Caekebeke
- Orthopedics and Traumatology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Angela Lucia Balocco
- From the Departments of Anesthesiology
- Faculty of Medicine and Life Sciences, Limburg Clinical Research Centre, UHasselt, Diepenbeek, Belgium
| | - Sam Van Boxstael
- From the Departments of Anesthesiology
- Faculty of Medicine and Life Sciences, Limburg Clinical Research Centre, UHasselt, Diepenbeek, Belgium
| | | |
Collapse
|
6
|
Van Boxstael S, Lopez AM, Balocco AL, Vandepitte C, Meex I, Duerinckx J, Kuroda MM, Mesotten D, Van Herreweghe I, Hadzic A. Effect of Lidocaine 2% Versus Bupivacaine 0.5% and 1 Versus 2 Dual Separate Injections on Onset and Duration of Ultrasound-Guided Wrist Blocks: A Blinded 2 × 2 Factorial Randomized Clinical Trial. Anesth Analg 2022; 134:1318-1325. [PMID: 35130196 DOI: 10.1213/ane.0000000000005936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Local anesthetics are often selected or mixed to accomplish faster onset of anesthesia. However, with ultrasound guidance, local anesthetics are delivered with greater precision, which may shorten the onset time with all classes of local anesthetics. In this study, we compared onset time and duration of ultrasound-guided wrist blocks with a fast onset versus a longer lasting local anesthetic administered via single or dual (spatially separate) injections at the level of the midforearm. METHODS In this randomized clinical trial, 36 subjects scheduled for carpal tunnel release were randomly assigned to receive ultrasound-guided median and ulnar nerve blocks with lidocaine 2% or bupivacaine 0.5% via single or dual injections (n = 9 in each group). Subjects fulfilled the study requirements. The main outcome variables were onset and duration of sensory blockade, which were tested separately in 2 (drug) × 2 (injection) analysis of variances (ANOVAs) with interaction terms. RESULTS Sensory block onset time did not differ significantly between subjects given lidocaine 2% (9.2 ± 3.4 minutes) or bupivacaine 0.5% (9.5 ± 3.1 minutes) (P = .76; mean difference, -0.3 ± 1.1 minutes [95% confidence interval {CI}, -2.5 to 1.9]) or between the single- (9.6 ± 2.8 minutes) and dual- (9.1 ± 3.6 minutes) injection groups (P = .69; mean difference, -0.4 ± 1.1 minutes [95% CI, -1.8 to 2.6]). Sensory duration was longer for subjects in the bupivacaine 0.5% group (27.3 ± 11.6 hours) than for subjects in the lidocaine 2% group (8.4 ± 4.1 hours) (P < .001; 95% CI, 12.7-25.1). However, sensory duration in the single- (15.7 ± 12.5 hours) and dual- (19.4 ± 13.1 hours) injection groups did not differ significantly (P = .28; mean difference, -3.7 ± 4.3 hours [95% CI, -12.6 to 5.1]). CONCLUSIONS No significant effect was found for onset time between lidocaine 2% and bupivacaine 0.5% used in ultrasound-guided wrist blocks. Dual injections did not shorten onset time. Since mean nerve block duration was longer with bupivacaine 0.5%, our results suggest that the selection of local anesthetic for the median and ulnar nerves at the level of the midforearm should be based on the desired duration of the block and not on its speed of onset.
Collapse
Affiliation(s)
- Sam Van Boxstael
- From the Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,UHasselt, Faculty of Medicine and Life Sciences & Limburg Clinical Research Centre, Diepenbeek, Belgium
| | - Ana M Lopez
- From the Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | | | - Ingrid Meex
- From the Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Joris Duerinckx
- Department of Orthopedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Maxine M Kuroda
- From the Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Dieter Mesotten
- From the Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,UHasselt, Faculty of Medicine and Life Sciences & Limburg Clinical Research Centre, Diepenbeek, Belgium
| | - Imre Van Herreweghe
- From the Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Admir Hadzic
- From the Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| |
Collapse
|
7
|
|
8
|
El-Boghdadly K, Wolmarans M, Stengel AD, Albrecht E, Chin KJ, Elsharkawy H, Kopp S, Mariano ER, Xu JL, Adhikary S, Altıparmak B, Barrington MJ, Bloc S, Blanco R, Boretsky K, Børglum J, Breebaart M, Burckett-St Laurent D, Capdevila X, Carvalho B, Chuan A, Coppens S, Costache I, Dam M, Egeler C, Fajardo M, Gadsden J, Gautier PE, Grant SA, Hadzic A, Hebbard P, Hernandez N, Hogg R, Holtz M, Johnson RL, Karmakar MK, Kessler P, Kwofie K, Lobo C, Ludwin D, MacFarlane A, McDonnell J, McLeod G, Merjavy P, Moran E, O'Donnell BD, Parras T, Pawa A, Perlas A, Rojas Gomez MF, Sala-Blanch X, Saporito A, Sinha SK, Soffin EM, Thottungal A, Tsui BCH, Tulgar S, Turbitt L, Uppal V, van Geffen GJ, Volk T, Elkassabany NM. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks. Reg Anesth Pain Med 2021; 46:571-580. [PMID: 34145070 DOI: 10.1136/rapm-2020-102451] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques. METHODS We conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement. RESULTS Sixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified. CONCLUSIONS Harmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice.
Collapse
Affiliation(s)
- Kariem El-Boghdadly
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human & Applied Physiological Sciences, King's College London, London, UK
| | - Morné Wolmarans
- Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
| | - Angela D Stengel
- American Society of Regional Anesthesia and Pain Medicine, Pittsburgh, Pennsylvania, USA
| | - Eric Albrecht
- Department of Anaesthesia, University of Lausanne, Lausanne, Switzerland
| | - Ki Jinn Chin
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Hesham Elsharkawy
- Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA.,Case Western Reserve University, Cleveland, Ohio, USA
| | - Sandra Kopp
- Anesthesiology, Mayo Clinic Graduate School for Biomedical Sciences, Rochester, Minnesota, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jeff L Xu
- Anesthesiology, Westchester Medical Center, Valhalla, New York, USA.,New York Medical College, Valhalla, New York, USA
| | - Sanjib Adhikary
- Anesthesiology and Perioperative Medicine, Penn State, University Park, Pennsylvania, USA
| | | | | | - Sébastien Bloc
- Anesthesiology Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, Île-de-France, France.,Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, Île-de-France, France
| | - Rafael Blanco
- Anaesthesia and Intensive Care, King's College Hospital Dubai, Abu Dhabi, UAE
| | - Karen Boretsky
- Anesthesiology, Critical Care and Pain Medicine, Harvard University, Cambridge, Massachusetts, USA
| | - Jens Børglum
- Department of Anesthesiology, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
| | | | | | - Xavier Capdevila
- Anesthesiology and Critical Care department, Hôpital Lapeyronie, Montpellier, Languedoc-Roussillon, France
| | | | - Alwin Chuan
- University of New South Wales Faculty of Medicine, Putney, New South Wales, Australia
| | | | - Ioana Costache
- Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Mette Dam
- Anaesthesiology, Zealand University Hospital Koge, Koge, Sjælland, Denmark
| | | | - Mario Fajardo
- Anesthesiology, Hospital Universitario de Mostoles, Mostoles, Madrid, Spain
| | - Jeff Gadsden
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Stuart Alan Grant
- Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Admir Hadzic
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium.,NYSORA, New York, New York, USA
| | - Peter Hebbard
- Department of Anesthesia Northeast Health Wangaratta, Ultrasound Education Group, The University of Melbourne Rural Health Academic Centre - Wangaratta, Wangaratta, Victoria, Australia
| | - Nadia Hernandez
- Anesthesiology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Rosemary Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Rebecca L Johnson
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Manoj Kumar Karmakar
- Department of Anesthesia and Intensice Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Paul Kessler
- Anesthesiology, Intensive Care and Pain Medicine, Universitätsklinikum Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Kwesi Kwofie
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Clara Lobo
- Anestesiologia, Hospital das Forças Armadas Polo do Porto, Porto, Portugal
| | | | - Alan MacFarlane
- Department of Cardiology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Graeme McLeod
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK.,Instittute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | | | - Eml Moran
- Letterkenny University Hospital, Letterkenny, Donegal, Ireland
| | - Brian D O'Donnell
- Department of Anesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland
| | | | - Amit Pawa
- Department of Anaesthesia, St Thomas' Hospital, London, UK.,Regional Anaesthesia - UK, London, UK
| | - Anahi Perlas
- Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Xavier Sala-Blanch
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain.,Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Andrea Saporito
- Anesthesia, Ospedale Regionale di Bellinzona e Valli Bellinzona, Bellinzona, Switzerland
| | - Sanjay Kumar Sinha
- Anesthesiology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | | | - Ban C H Tsui
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Serkan Tulgar
- Anesthesiology and reanimatiom, Maltepe Universitesi Tip Fakultesi, Maltepe, Turkey
| | - Lloyd Turbitt
- Royal Victoria Hospital Laboratory and Mortuary Services, Belfast, UK
| | - Vishal Uppal
- Anesthesia, Dalhousie University - Faculty of Health Professions, Halifax, Nova Scotia, Canada
| | - Geert J van Geffen
- Anesthesiology, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany.,Saarland University, Saarbrucken, Saarland, Germany
| | - Nabil M Elkassabany
- Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
9
|
Balocco AL, López AM, Kesteloot C, Horn JL, Brichant JF, Vandepitte C, Hadzic A, Gautier P. Quadratus lumborum block: an imaging study of three approaches. Reg Anesth Pain Med 2020; 46:35-40. [PMID: 33159007 DOI: 10.1136/rapm-2020-101554] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Different injection techniques for the quadratus lumborum (QL) block have been described. Data in human cadavers suggest that the transverse oblique paramedian (TOP) QL3 may reach the thoracic paravertebral space more consistently than the QL1 and QL2. However, the distribution of injectate in cadavers may differ from that in patients. Hence, we assessed the distribution of the injectate after the QL1, QL2, and TOP QL3 techniques in patients. MATERIALS AND METHODS Thirty-four patients scheduled for abdominal surgery received QL blocks postoperatively; 26 patients received bilateral and 8 patients received unilateral blocks. Block injections were randomly allocated to QL1, QL2, or TOP QL3 techniques (20 blocks per each technique). The injections consisted of 18 mL of ropivacaine 0.375% with 2 mL of radiopaque contrast, injected lateral or posterior to the QL muscle for the QL1 and QL2 techniques, respectively. For the TOP QL3, the injection was into the plane between the QL and psoas muscles, proximal to the L2 transverse process. Two reviewers, blinded to the allocation, reviewed three-dimensional computed tomography (3D-CT) images to assess the distribution of injectate. RESULTS AND DISCUSSION The QL1 block spread in the transversus abdominis plane (TAP), QL2 in the TAP, and posterior aspect of the QL muscle, whereas TOP QL3 spread consistently in the anterior aspect of the QL muscle with occasional spread to the lumbar and thoracic paravertebral areas. CONCLUSIONS The spread of injectate after QL1, QL2, and QL3 blocks, resulted in different distribution patterns, primarily in the area of injection. The TOP QL3 did not result in consistent interfascial spread toward the thoracic paravertebral space.
Collapse
Affiliation(s)
| | - Ana M López
- Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | - Cedric Kesteloot
- Anesthesiology, Clinique Sainte-Anne Saint-Remi, Brussels, Belgium
| | - Jean-Louis Horn
- Anesthesiology, Stanford University, Stanford, California, USA
| | - Jean-François Brichant
- Anesthesiology and Intensive Care Medicine, Centre Hospitalier Universitaire de Liège, Liege, Belgium
| | | | - Admir Hadzic
- Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | - Philippe Gautier
- Anesthesiology, Clinique Sainte-Anne Saint-Remi, Brussels, Belgium
| |
Collapse
|
10
|
Hadzic A, Vandepitte C, Knezevic NN, Mesotten D, Kuroda MM, Van Boxstael S, Bellemans J, Van de Velde M, Fivez T, Corten K. Clinical research and trial registries: the times they are a-changin. Reg Anesth Pain Med 2020; 45:844-846. [PMID: 32784230 DOI: 10.1136/rapm-2020-101851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Admir Hadzic
- Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | | | - Nebojsa Nick Knezevic
- Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.,Anesthesiology and Surgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Dieter Mesotten
- Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium.,Faculty of Medicine and Life Sciences & Limburg Clinical Research Center, Hasselt University, Diepenbeek, Limburg, Belgium
| | - Maxine M Kuroda
- Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | | | - Johan Bellemans
- Orthopedic Surgery, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | | | - Tom Fivez
- Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | - Kristoff Corten
- Orthopedic Surgery, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| |
Collapse
|
11
|
Someili A, Alosail A, Brooks A, Irfan N, Leto D, Hadzic A, Alajmi A, Mertz D, Bader M. A100 ORAL VANCOMYCIN THERAPY FOR CLOSTRIDIOIDES DIFFICILE INFECTION AND RISK OF INFECTION WITH GRAM-NEGATIVE ORGANISMS. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vancomycin is the recommended first-line therapy for mild to severe Clostridioides difficile infection (CDI). However, oral vancomycin is associated with disruption of the indigenous microbiota, predisposing patients to overgrowth of endogenous pathogens such as vancomycin-resistant enterococci.
Aims
The primary objective of the study is to examine the effect of the treatment regimens of CDI on the risk of infection with gram-negative organisms in adult patients treated for CDI.
Methods
A retrospective cohort study of 319 adult patients treated for CDI at Hamilton Health Sciences in the year 2015. A multivariate logistic regression analysis was performed to determine if oral vancomycin-based therapy is associated with an increased risk of infection with gram-negative organisms after adjustment for other factors.
Results
Eighty-one patients were excluded because of recurrent episodes of CDI within the same year or missing information. 238 patients were included in the final analysis. 48 (20.2%) patients had positive culture for gram-negative organisms after onset of CDI. Urine was the most common source for gram-negative organisms (39/48, 81.3%) followed by blood (8/48,16.7%). The most common isolated gram-negative organisms were Escherichia coli (18/48, 37.5%) and Klebsiella pneumonia (9/48, 18.8%).
The most common CDI treatment regimens were metronidazole monotherapy (137/238, 57.6%), vancomycin monotherapy (13/238, 5.5%), and combination therapy (88/238, 37.0%). Among patients who were treated with metronidazole monotherapy, vancomycin monotherapy, and combination therapy, 30(30/137, 21.9%), 3 (3/13,23.1%), and 15 (15/88, 17.1%) had positive culture for gram-negative organisms, respectively (P= 0.6).
Ninety-seven (97/238,40.8%) patients had severe CDI, 40 (40/97, 41.2%) were treated with metronidazole monotherapy, 5(5/97, 5.2%) with vancomycin monotherapy, and 52 (52/97, 53.6%) with combination therapy. 26 (26/141,18.4%) and 22 (22/97, 22.7%) had positive culture for gram-negative organisms among patients with non-severe and severe CDI, receptively (P= 0.7). In the multivariate analysis, neither type of CDI treatment regimen (P=0.2, 95% CI 0.30–1.31) nor CDI severity (P=0.4, 95% CI 0.67–2.69) was associated an increased risk of infection with gram-negative organisms after CDI onset.
Conclusions
Contrary to the reported literature, we did not find that oral vancomycin-based CDI treatment was associated with increased risk of infection with gram-negative organisms.
Funding Agencies
None
Collapse
Affiliation(s)
- A Someili
- McMaster university, Hamilton, ON, Canada
| | - A Alosail
- McMaster university, Hamilton, ON, Canada
| | - A Brooks
- McMaster university, Hamilton, ON, Canada
| | - N Irfan
- McMaster university, Hamilton, ON, Canada
| | - D Leto
- McMaster university, Hamilton, ON, Canada
| | - A Hadzic
- McMaster university, Hamilton, ON, Canada
| | - A Alajmi
- McMaster university, Hamilton, ON, Canada
| | - D Mertz
- McMaster university, Hamilton, ON, Canada
| | - M Bader
- McMaster university, Hamilton, ON, Canada
| |
Collapse
|
12
|
Vandepitte CF, Van Boxstael S, Duerinckx JF, Leunen I, Kuroda MM, Mesotten D, Van De Velde M, Hadzic A. Effect of Bupivacaine Liposome Injectable Suspension on Sensory Blockade and Analgesia for Dupuytren Contracture Release. Journal of Hand Surgery Global Online 2019. [DOI: 10.1016/j.jhsg.2019.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
|
13
|
Monzó E, Hadzic A. Costoclavicular approach to the brachial plexus block: simple or double injection? Reg Anesth Pain Med 2019:rapm-2019-100852. [PMID: 31570494 DOI: 10.1136/rapm-2019-100852] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/31/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Enrique Monzó
- Department of Anesthesiology, Montepríncipe University Hospital, Madrid, Spain
| | - Admir Hadzic
- Anesthesiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium
| |
Collapse
|
14
|
Hauritz RW, Hannig KE, Balocco AL, Peeters G, Hadzic A, Børglum J, Bendtsen TF. Peripheral nerve catheters: A critical review of the efficacy. Best Pract Res Clin Anaesthesiol 2019; 33:325-339. [PMID: 31785718 DOI: 10.1016/j.bpa.2019.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
Continuous peripheral nerve blocks are commonly used for postoperative analgesia after surgery. However, catheter failure may occur due to either primary (incorrect insertion) or secondary reasons (displacement, obstruction, disconnection). Catheter failure results in unanticipated pain, need for opioid use, and risk of readmission or delay in hospital discharge. This review aimed to assess definition and frequency of catheter failure, and discuss the alternatives to prolong duration of single-shot nerve blocks. A literature search was performed on peripheral catheters reporting failure as the main outcome measure. Thirty-three studies met the selection criteria, comprising 2711 catheters. Literature review suggests that peripheral nerve catheters have clinically significant failure rate when the assessment is performed using an objective (imaging) method. Subjective methods of assessment (without imaging) may underestimate the incidence of catheter failure.
Collapse
Affiliation(s)
- Rasmus W Hauritz
- Department of Anesthesia and Intensive Care Medicine, Kolding Hospital, Denmark
| | - Kjartan E Hannig
- Department of Anesthesia and Intensive Care Medicine, Kolding Hospital, Denmark
| | - Angela Lucia Balocco
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Gwendolyne Peeters
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Admir Hadzic
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Jens Børglum
- Department of Anesthesia and Intensive Care Medicine, Zealand University Hospital, Denmark
| | | |
Collapse
|
15
|
Vermeylen K, Desmet M, Leunen I, Soetens F, Neyrinck A, Carens D, Caerts B, Seynaeve P, Hadzic A, Van de Velde M. Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study. Reg Anesth Pain Med 2019; 44:rapm-2018-100092. [PMID: 30798268 DOI: 10.1136/rapm-2018-100092] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/22/2018] [Accepted: 10/28/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Lumbar plexus block has been used to provide postoperative analgesia after lower limb surgery. The fascia iliaca compartment block (FICB) has been proposed as an anterior approach of the lumbar plexus targeting the femoral, obturator and lateral femoral cutaneous nerve. However, both radiological and clinical evidence demonstrated that an infra-inguinal approach to the fascia iliaca compartment does not reliably block the three target nerves.We hypothesized that a supra-inguinal approach of the fascia iliaca compartment results in a more consistent block of the three target nerves than an infra-inguinal approach. METHODS We performed a randomized controlled, double-blind trial in 10 healthy volunteers. Both an infra-inguinal FICB (I-FICB) and a supra-inguinal FICB (S-FICB) were performed on the left or the right side in each volunteer. Forty milliliters of lidocaine 0.5% was injected with each approach. Sensory and motor block and spread of local anesthetics (LA) on MRI were assessed. RESULTS After an S-FICB, 80% of the volunteers had a complete sensory block of the medial, anterior and lateral region of the thigh, compared with 30% after an I-FICB (p=0.035). There was an insignificant effect on motor function with both approaches. After an S-FICB, in 8 out of 10 volunteers there was spread of LA in the expected anatomic location of the obturator nerve on MRI compared with 1 out of 10 volunteers after an I-FICB (p=0.0017). The cranial spread of LA after an S-FICB on MRI was higher than after an I-FICB (p=0.007), whereas there was a more caudal spread of LA on MRI after an I-FICB than after an S-FICB (p=0.005). CONCLUSIONS An S-FICB produces a more complete sensory block of the medial, anterior and lateral region of the thigh, compared with an I-FICB. Our study demonstrates that an S-FICB with 40 mL of LA more reliably spreads LA to the anatomical location of the three target nerves of the lumbar plexus on MRI than an I-FICB. An S-FICB also leads to a more consistent spread in a cranial direction under the fascia iliaca and around the psoas muscle. CLINICAL TRIAL REGISTRATION This work was registered with the European clinical trial registry: Identifier Eudra CT 2015-004607-24.
Collapse
Affiliation(s)
- Kris Vermeylen
- Department of Anesthesia, AZ Turnhout, Turnhout, Belgium
| | | | - Ine Leunen
- Department of Anesthesia, AZ Turnhout, Turnhout, Belgium
| | - Filiep Soetens
- Department of Anesthesia, AZ Turnhout, Turnhout, Belgium
| | - Arne Neyrinck
- Department of Anesthesiology, UZ Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Dirk Carens
- FIKS Groepspraktijk (private practice), Antwerp, Belgium
| | - Ben Caerts
- Department of Radiology, AZ Turnhout, Turnhout, Belgium
| | | | - Admir Hadzic
- Department of Anesthesia, Consultant, ZOL, Genk, Belgium
| | - Marc Van de Velde
- Department of Cardiovascular Sciences, KU Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
16
|
Gautier N, Danklou J, Brichant JF, Lopez AM, Vandepitte C, Kuroda MM, Hadzic A, Gautier PE. The effect of force applied to the left paratracheal oesophagus on air entry into the gastric antrum during positive-pressure ventilation using a facemask. Anaesthesia 2018; 74:22-28. [DOI: 10.1111/anae.14442] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 12/31/2022]
Affiliation(s)
- N. Gautier
- Department of Anesthesiology; University of Louvain; St Luc Hospital; Brussels Belgium
| | - J. Danklou
- Department of Anesthesia and Intensive Care Medicine; Liege University Hospital; Liege Belgium
| | - J. F. Brichant
- Department of Anesthesia and Intensive Care Medicine; Liege University Hospital; Liege Belgium
| | - A. M. Lopez
- Department of Anesthesiology; Hospital Clinic de Barcelona; Barcelona Spain
| | - C. Vandepitte
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Algology; ZOL; Genk Belgium
| | - M. M. Kuroda
- New York School of Regional Anesthesia (NYSORA); New York USA
| | - A. Hadzic
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Algology; ZOL; Genk Belgium
| | - P. E. Gautier
- Service D'Anesthesie; Clinique St Anne-St Remi; CHIREC; Bruxelles Belgium
| |
Collapse
|
17
|
Das Adhikary S, Karanzalis D, Liu WMR, Hadzic A, McQuillan PM. A Prospective Randomized Study to Evaluate a New Learning Tool for Ultrasound-Guided Regional Anesthesia. Pain Med 2017; 18:856-865. [PMID: 28034969 DOI: 10.1093/pm/pnw287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective To evaluate the effectiveness of a new learning tool for needle insertion accuracy skills during a simulated ultrasound-guided regional anesthesia procedure. Methods Thirty participants were included in this randomized controlled study. After viewing a prerecorded video of a single, discreet, ultrasound-guided regional anesthesia task, all participants performed the same task three consecutive times (pretest), and needle insertion accuracy skills in a phantom model were recorded as baseline. All participants were then randomized into two groups, experimental and control. The experimental group practiced the task using the new tool, designed with two video cameras, a monitor, and an ultrasound machine where the images from the ultrasound and video of hand movements are viewed simultaneously on the monitor. The control group practiced the task without using the new tool. After the practice session, both groups repeated the same task and were evaluated in the same manner as in the pretest. Results Participants in both group groups had similar baseline characteristics with respect to previous experience with ultrasound-guided regional anesthesia procedures. The experimental group had significantly better needle insertion accuracy scores ( P < 0.01) than the control group. Using the new learning tool, inexperienced participants had better needle insertion accuracy scores ( P < 0.01) compared with experienced participants. Conclusions This study demonstrates that the use of this new learning tool results in short-term improvement in hand-eye, motor, and basic needle insertion skills during a simulated ultrasound-guided regional anesthesia procedure vs traditional practice methods. Skill improvement was greater in novices compared with experienced participants.
Collapse
Affiliation(s)
- Sanjib Das Adhikary
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Demetrius Karanzalis
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Wai-Man Raymond Liu
- Research School of Finance, Actuarial Studies and Applied Statistics, The Australian National University, Acton, Australia
| | - Admir Hadzic
- Department of Anesthesia, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Patrick M McQuillan
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| |
Collapse
|
18
|
Goffin P, Lecoq JP, Ninane V, Brichant JF, Sala-Blanch X, Gautier PE, Bonnet P, Carlier A, Hadzic A. Interfascial Spread of Injectate After Adductor Canal Injection in Fresh Human Cadavers. Anesth Analg 2016; 123:501-3. [DOI: 10.1213/ane.0000000000001441] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
19
|
Abstract
Liposome bupivacaine is a prolonged-release liposomal formulation of bupivacaine indicated for single-dose infiltration into the surgical site to produce postsurgical analgesia of longer duration than traditional local anesthetics. This review summarizes the available data on how volume expansion may impact the analgesic efficacy of liposome bupivacaine. The Phase II and III clinical studies that involved surgical site administration of liposome bupivacaine at various concentrations in different surgical settings revealed no apparent concentration–efficacy relationship. A single-center, prospective study comparing the efficacy of transversus abdominis plane infiltration with liposome bupivacaine administered in a lower (266 mg/40 mL) vs a higher (266 mg/20 mL) dose concentration in subjects undergoing robotic-assisted laparoscopic prostatectomy also reported similar postsurgical pain intensity scores and opioid usage in both treatment groups. The pharmacokinetic profile of liposome bupivacaine following subcutaneous injections in rats was unaltered by differences in drug concentration, dose, or injection volume within the ranges tested. Volume expansion of liposome bupivacaine to a total volume of 300 mL or less does not appear to impact its clinical efficacy or pharmacokinetic profile, thus allowing flexibility to administer the formulation across a wide range of diluent volumes.
Collapse
Affiliation(s)
- Admir Hadzic
- Department of Anesthesiology, The New York School of Regional Anesthesia (NYSORA), New York, NY, USA ; Department of Anesthesiology, Ziekenhouse Oost Limburgh, Genk, Belgium, USA
| | | | | |
Collapse
|
20
|
Damjanovska M, Cvetko E, Hadzic A, Seliskar A, Plavec T, Mis K, Vuckovic Hasanbegovic I, Stopar Pintaric T. Neurotoxicity of perineural vs intraneural-extrafascicular injection of liposomal bupivacaine in the porcine model of sciatic nerve block. Anaesthesia 2015; 70:1418-26. [PMID: 26338496 PMCID: PMC5049634 DOI: 10.1111/anae.13189] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 11/30/2022]
Abstract
Liposomal bupivacaine is a prolonged-release local anaesthetic, the neurotoxicity of which has not yet been determined. We used quantitative histomorphometric and immunohistochemical analyses to evaluate the neurotoxic effect of liposomal bupivacaine after perineural and intraneural (extrafascicular) injection of the sciatic nerve in pigs. In this double-blind prospective randomised trial, 4 ml liposomal bupivacaine 1.3% was injected either perineurally (n = 5) or intraneurally extrafascicularly (n = 5). Intraneural-extrafascicular injection of saline (n = 5) was used as a control. After emergence from anaesthesia, neurological examinations were conducted over two weeks. After harvesting the sciatic nerves, no changes in nerve fibre density or myelin width indicative of nerve injury were observed in any of the groups. Intraneural injections resulted in longer sensory blockade than perineural (p < 0.003) without persistent motor or sensory deficit. Sciatic nerve block with liposomal bupivacaine in pigs did not result in histological evidence of nerve injury.
Collapse
Affiliation(s)
- M Damjanovska
- Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - E Cvetko
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - A Hadzic
- NAICE (North American Institute for Continuing Education), New York, NY, USA.,NYSORA (The New York School of Regional Anesthesia), New York, NY, USA.,Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - A Seliskar
- Clinic for Small Animal Medicine and Surgery, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - T Plavec
- Clinic for Small Animal Medicine and Surgery, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - K Mis
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - I Vuckovic Hasanbegovic
- Department of Anatomy, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - T Stopar Pintaric
- Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
21
|
Abstract
This review synthesizes anatomical, anesthetic, surgical, and patient factors that may contribute to neurologic complications associated with peripheral nerve blockade. Peripheral nerves have anatomical features unique to a given location that may influence risk of injury. Peripheral nerve blockade-related peripheral nerve injury (PNI) is most severe with intrafascicular injection. Surgery and its associated requirements such as positioning and tourniquet have specific risks. Patients with preexisting neuropathy may be at an increased risk of postoperative neurologic dysfunction. Distinguishing potential causes of PNI require clinical assessment and investigation; a definitive diagnosis, however, is not always possible. Fortunately, most postoperative neurologic dysfunction appears to resolve with time, and the incidence of serious long-term nerve injury directly attributable to peripheral nerve blockade is relatively uncommon. Nonetheless, despite the use of ultrasound guidance, the risk of block-related PNI remains unchanged. WHAT'S NEW Since the 2008 Practice Advisory, new information has been published, furthering our understanding of the microanatomy of peripheral nerves, mechanisms of peripheral nerve injection injury, toxicity of local anesthetics, the etiology of and monitoring methods, and technologies that may decrease the risk of nerve block-related peripheral nerve injury.
Collapse
Affiliation(s)
- Richard Brull
- From the *Departments of Anesthesia, Toronto Western Hospital, University Health Network, and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; †Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, St Luke's and Roosevelt Hospitals, New York, NY; ‡School of Medicine, CEU San Pablo University, and Madrid Montepríncipe University Hospital, Madrid, Spain; and §Department of Anaesthesia, St Vincent's Hospital; Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | |
Collapse
|
22
|
Gautier P, Vandepitte C, Schaub I, Fourneau K, Kuroda MM, De Merlier Y, Hadzic A. The Disposition of Radiocontrast in the Interscalene Space in Healthy Volunteers. Anesth Analg 2015; 120:1138-1141. [DOI: 10.1213/ane.0000000000000649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
23
|
Affiliation(s)
- Sven Van Poucke
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Pain Therapy, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Michiel Thomeer
- Department of Respiratory Medicine, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Admir Hadzic
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| |
Collapse
|
24
|
Lopez AM, Sala-Blanch X, Castillo R, Hadzic A. Ultrasound guided injection inside the common sheath of the sciatic nerve at division level has a higher success rate than an injection outside the sheath. Rev Esp Anestesiol Reanim 2014; 61:304-310. [PMID: 24556512 DOI: 10.1016/j.redar.2013.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/06/2013] [Accepted: 11/16/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVE The recommendations for the level of injection and ideal placement of the needle tip required for successful ultrasound-guided sciatic popliteal block vary among authors. A hypothesis was made that, when the local anesthetic is injected at the division of the sciatic nerve within the common connective tissue sheath, the block has a higher success rate than an injection outside the sheath. METHODS Thirty-four patients scheduled for hallux valgus repair surgery were randomized to receive either a sub-sheath block (n=16) or a peri-sheath block (n=18) at the level of the division of the sciatic nerve at the popliteal fossa. For the sub-sheath block, the needle was advanced out of plane until the tip was positioned between the tibial and peroneal nerves, and local anesthetic was then injected without moving the needle. For the peri-sheath block, the needle was advanced out of plane both sides of the sciatic nerve, to surround the sheath. Mepivacaine 1.5% and levobupivacaine 0.5% 30mL were used in both groups. The progression of motor and sensory block was assessed at 5min intervals. Duration of block was recorded. RESULTS Adequate surgical block was achieved in all patients in the subsheath group (100%) compared to 12 patients (67%) in the peri-sheath group at 30min. Sensory block was achieved faster in the subsheath than peri-sheath (9.1±7.4min vs. 19.0±4.0; p<.001). CONCLUSIONS Our study suggests that for successful sciatic popliteal block in less than 30min, local anesthetic should be injected within the sheath.
Collapse
Affiliation(s)
- A M Lopez
- Department of Anesthesiology, Hospital Clínic Barcelona, Barcelona, Spain.
| | - X Sala-Blanch
- Department of Anesthesiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - R Castillo
- Department of Anesthesiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - A Hadzic
- Department of Anesthesiology, St Luke's-Roosevelt Hospital, College of Physicians and Surgeons, Columbia University, New York, USA
| |
Collapse
|
25
|
Vandepitte C, Latmore M, O’Murchu E, Hadzic A, Van de Velde M, Nijs S. Combined interscalene-superficial cervical plexus blocks for surgical repair of a clavicular fracture in a 15-week pregnant woman. Int J Obstet Anesth 2014; 23:194-5. [DOI: 10.1016/j.ijoa.2013.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/03/2013] [Accepted: 10/07/2013] [Indexed: 11/15/2022]
|
26
|
Pintaric TS, Cvetko E, Strbenc M, Mis K, Podpecan O, Mars T, Hadzic A. Intraneural and Perineural Inflammatory Changes in Piglets After Injection of Ultrasound Gel, Endotoxin, 0.9% NaCl, or Needle Insertion without Injection. Anesth Analg 2014; 118:869-73. [DOI: 10.1213/ane.0000000000000142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
27
|
Levine M, Latmore M, Vandepitte C, Gadsden J, Hadzic A. It is 3 a.m. . . . do you know where your catheter tip is? Br J Anaesth 2014; 112:757-8. [DOI: 10.1093/bja/aeu069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
28
|
Wiesmann T, Bornträger A, Vassiliou T, Hadzic A, Wulf H, Müller HH, Steinfeldt T. Minimal Current Intensity to Elicit an Evoked Motor Response Cannot Discern Between Needle-Nerve Contact and Intraneural Needle Insertion. Anesth Analg 2014; 118:681-6. [DOI: 10.1213/ane.0b013e3182a94454] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
29
|
Ruiz A, Sala-Blanch X, Martinez-Ocón J, Carretero MJ, Sánchez-Etayo G, Hadzic A. Incidence of intraneural needle insertion in ultrasound-guided femoral nerve block: a comparison between the out-of-plane versus the in-plane approaches. Rev Esp Anestesiol Reanim 2014; 61:73-77. [PMID: 24314696 DOI: 10.1016/j.redar.2013.09.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/17/2013] [Accepted: 09/25/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND The optimal method of ultrasound-guided femoral nerve block (in-plane vs. out-of-plane) has not been established. We tested the hypothesis that the incidence of needle-nerve contact may be higher with out-of-plane than with in-plane needle insertion. METHODS Forty-four patients with hip fracture (American Society of Anaesthesiologists physical status I-III) were randomized to receive the femoral block with an out-of-plane approach (needle inserted at a 45-60° angle 1cm caudal to the midpoint of the ultrasound probe just above the femoral nerve) or with an in-plane technique (needle inserted 0.2-0.4 cm from the side of the probe lateral to the femoral nerve). Data collected included depth of needle insertion, response to nerve electric stimulation, and distribution of the injected volume in relation to the nerve (anterior vs. posterior, the latter assuming needle-nerve contact). The sensory block onset was tested at 20 min and block recovery and any neurologic symptoms were evaluated at 24h. RESULTS The incidence of needle-nerve contact was significantly higher with the out-of-plane approach (14/22 patients [64%]) than with the in-plane approach (2/22 patients [9%]) (p<0.001) (OR=17.5, 95% CI: 4-79). The rate of paraesthesia on crossing the fascia iliaca was similar in the two groups. All blocks uneventfully regressed; and no patient developed neurologic symptoms. CONCLUSIONS Under the conditions of our study, needle-nerve contact during femoral nerve block occurs frequently with the out-of-plane approach. An in-plane approach results in an equally effective femoral block and less incidence of needle-nerve contact.
Collapse
Affiliation(s)
- A Ruiz
- Department of Anaesthesiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - X Sala-Blanch
- Department of Anaesthesiology, Hospital Clínic, Universitat de Barcelona, Spain.
| | - J Martinez-Ocón
- Department of Anaesthesiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - M J Carretero
- Department of Anaesthesiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - G Sánchez-Etayo
- Department of Anaesthesiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - A Hadzic
- Department of Anaesthesia, St Luke's - Roosevelt Hospital Center, University Hospital of Columbia University, New York, USA
| |
Collapse
|
30
|
Salviz EA, Xu D, Frulla A, Kwofie K, Shastri U, Chen J, Shariat AN, Littwin S, Lin E, Choi J, Hobeika P, Hadzic A. Continuous Interscalene Block in Patients Having Outpatient Rotator Cuff Repair Surgery. Anesth Analg 2013; 117:1485-92. [DOI: 10.1213/01.ane.0000436607.40643.0a] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
31
|
Wassef M, Lee DY, Levine JL, Ross RE, Guend H, Vandepitte C, Hadzic A, Teixeira J. Feasibility and analgesic efficacy of the transversus abdominis plane block after single-port laparoscopy in patients having bariatric surgery. J Pain Res 2013; 6:837-41. [PMID: 24348067 PMCID: PMC3849080 DOI: 10.2147/jpr.s50561] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The transversus abdominis plane (TAP) block is a technique increasingly used for analgesia after surgery on the anterior abdominal wall. We undertook this study to determine the feasibility and analgesic efficacy of ultrasound-guided TAP blocks in morbidly obese patients. We describe the dermatomal spread of local anesthetic in TAP blocks administered, and test the hypothesis that TAP blocks decrease visual analog scale (VAS) scores. Patients and methods After ethics committee approval and informed consent, 35 patients with body mass index >35 undergoing single-port sleeve gastrectomy (SPSG) were enrolled. All patients received balanced general anesthesia, followed by intravenous patient-controlled analgesia (IV-PCA; hydromorphone) postoperatively; all reported VAS >3 upon arrival to the recovery room. From the cohort of 35 patients having single-port laparoscopy (SPL), a sealed envelope method was used to randomly select ten patients to the TAP group and 25 patients to the control group. The ten patients in the TAP group received ultrasound-guided TAP blocks with 30 mL of 0.2% Ropivacaine injected bilaterally. The dermatomal distribution of the sensory block (by pinprick test) was recorded. VAS scores for the first 24 hours after surgery and opioid use were compared between the IV-PCA+TAP block and IV-PCA only groups. Results Sensory block ranged from T5–L1. Mean VAS pain scores decreased from 8 ± 2 to 4 ± 3 (P=0.04) within 30 minutes of TAP block administration. Compared with patients given IV-PCA only, significantly fewer patients who received TAP block had moderate or severe pain (VAS 4–10) after block administration at 6 hours and 12 hours post-surgery. However, cumulative consumption of hydromorphone at 24 hours after SPSG surgery was similar for both groups. Conclusion Ultrasound-guided TAP blocks in morbidly obese patients are feasible and result in satisfactory analgesia following SPSG in the immediate postoperative period.
Collapse
Affiliation(s)
- Michael Wassef
- Department of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - David Y Lee
- Department of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - Jun L Levine
- Department of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - Ronald E Ross
- Department of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - Hamza Guend
- Department of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - Catherine Vandepitte
- Department of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - Admir Hadzic
- Department of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - Julio Teixeira
- Department of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, NY, USA
| |
Collapse
|
32
|
Adhikary SD, Hadzic A, McQuillan PM. Simulator for teaching hand-eye coordination during ultrasound-guided regional anaesthesia. Br J Anaesth 2013; 111:844-5. [PMID: 24108733 DOI: 10.1093/bja/aet364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
33
|
Vandepitte C, Gautier P, Bellen P, Murata H, Salviz EA, Hadzic A. Use of ultrasound-guided intercostal nerve block as a sole anaesthetic technique in a high-risk patient with Duchenne muscular dystrophy. Acta Anaesthesiol Belg 2013; 64:91-94. [PMID: 24191530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Duchenne muscular dystrophy is a progressive neuromuscular disease. Mortality is typically related to combined respiratory failure and dilated cardiomyopathy. Surgery under general anesthesia or deep sedation presents increased risks for pulmonary complications or ventilator dependency postoperatively. We describe the utility of ultrasound guided intercostal nerve blocks for surgery on the chest wall in a patient with Duchenne muscular dystrophy and severe respiratory compromise.
Collapse
Affiliation(s)
- C Vandepitte
- Department of Anesthesiology, Catholic University of Leuven, Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
34
|
Murata H, Salviz EA, Chen S, Vandepitte C, Hadzic A. Ultrasound-Guided Continuous Thoracic Paravertebral Block for Outpatient Acute Pain Management of Multilevel Unilateral Rib Fractures. Anesth Analg 2013; 116:255-7. [DOI: 10.1213/ane.0b013e31826f5e25] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
35
|
Karmakar MK, Li X, Li J, Hadzic A. Volumetric Three-Dimensional Ultrasound Imaging of the Anatomy Relevant for Thoracic Paravertebral Block. Anesth Analg 2012; 115:1246-50. [DOI: 10.1213/ane.0b013e318266c37d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
36
|
Gadsden J, Shariat A, Hadzic A, Xu D, Patel V, Maliakal T. The Sequence of Administration of 1.5% Mepivacaine and 0.5% Bupivacaine Does Not Affect Latency of Block Onset or Duration of Analgesia in Ultrasound-Guided Interscalene Block. Anesth Analg 2012; 115:963-7. [DOI: 10.1213/ane.0b013e318265ba9a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
37
|
Murata H, Sakai A, Hadzic A, Sumikawa K. The Presence of Transverse Cervical and Dorsal Scapular Arteries at Three Ultrasound Probe Positions Commonly Used in Supraclavicular Brachial Plexus Blockade. Anesth Analg 2012; 115:470-3. [DOI: 10.1213/ane.0b013e3182568557] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
38
|
Vandepitte C, Vloka J, Gadsden J, Hadzic A. Evoked Motor Response of the Sartorius Muscle and Femoral Nerve Blockade. Anesth Analg 2012; 114:1140; author reply 1140-1. [DOI: 10.1213/ane.0b013e31824bed05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
39
|
Sala-Blanch X, de Riva N, Carrera A, López AM, Prats A, Hadzic A. Ultrasound-Guided Popliteal Sciatic Block with a Single Injection at the Sciatic Division Results in Faster Block Onset than the Classical Nerve Stimulator Technique. Anesth Analg 2012; 114:1121-7. [DOI: 10.1213/ane.0b013e318248e1b3] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
40
|
Stopar Pintaric T, Veranic P, Hadzic A, Karmakar M, Cvetko E. Electron-Microscopic Imaging of Endothoracic Fascia in the Thoracic Paravertebral Space in Rats. Reg Anesth Pain Med 2012; 37:215-8. [DOI: 10.1097/aap.0b013e31824451cb] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
41
|
Gandhi K, Lindenmuth DM, Hadzic A, Xu D, Patel VS, Maliakal TJ, Gadsden JC. The effect of stimulating versus conventional perineural catheters on postoperative analgesia following ultrasound-guided femoral nerve localization. J Clin Anesth 2011; 23:626-31. [DOI: 10.1016/j.jclinane.2011.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Revised: 04/05/2011] [Accepted: 04/22/2011] [Indexed: 10/14/2022]
|
42
|
Gautier P, Vandepitte C, Ramquet C, DeCoopman M, Xu D, Hadzic A. The Minimum Effective Anesthetic Volume of 0.75% Ropivacaine in Ultrasound-Guided Interscalene Brachial Plexus Block. Anesth Analg 2011; 113:951-5. [DOI: 10.1213/ane.0b013e31822b876f] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
43
|
Gadsden J, Hadzic A, Gandhi K, Shariat A, Xu D, Maliakal T, Patel V. The Effect of Mixing 1.5% Mepivacaine and 0.5% Bupivacaine on Duration of Analgesia and Latency of Block Onset in Ultrasound-Guided Interscalene Block. Anesth Analg 2011; 112:471-6. [DOI: 10.1213/ane.0b013e3182042f7f] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
44
|
|
45
|
|
46
|
Robards C, Hadzic A, Somasundaram L, Iwata T, Gadsden J, Xu D, Sala-Blanch X. Intraneural Injection with Low-Current Stimulation During Popliteal Sciatic Nerve Block. Anesth Analg 2009; 109:673-7. [PMID: 19608846 DOI: 10.1213/ane.0b013e3181aa2d73] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
47
|
Gadsden JC, Tsai T, Iwata T, Somasundarum L, Robards C, Hadzic A. Low interscalene block provides reliable anesthesia for surgery at or about the elbow. J Clin Anesth 2009; 21:98-102. [PMID: 19329012 DOI: 10.1016/j.jclinane.2008.06.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 06/18/2008] [Accepted: 06/25/2008] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To determine whether interscalene brachial plexus block (ISB) provides adequate anesthesia for surgery on or about the elbow. STUDY DESIGN Case series. SETTING Operating room of an academic teaching hospital. PATIENTS 78 patients scheduled for elective elbow surgery. INTERVENTIONS All patients received an ISB using a low approach technique. A stimulating needle was inserted in the interscalene groove two cm above the clavicle. A volume of 35-45 mL of mepivacaine 1.5% or ropivacaine 0.5% was administered after obtaining a motor response of any component of the brachial plexus with a current intensity of 0.2-0.4 mA (0.1 msec). MEASUREMENTS Block success rate, defined as the ability to complete surgery without use of intraoperative opioids or general anesthesia, was assessed. Verbal rating scores for pain (0 = no pain, 10 = worst pain imaginable) were obtained in the recovery room. MAIN RESULTS Low ISB resulted in successful surgical anesthesia in 75 (96%) of the study patients. Verbal rating scores were low (0-2) for all patients postoperatively. CONCLUSIONS The low interscalene block can be used to provide surgical anesthesia in the majority of patients having surgery on or about the elbow.
Collapse
Affiliation(s)
- Jeff C Gadsden
- Department of Anesthesiology, College of Physicians & Surgeons, Columbia University, New York, NY, USA.
| | | | | | | | | | | |
Collapse
|
48
|
Sala Blanch X, López AM, Carazo J, Hadzic A, Carrera A, Pomés J, Valls-Solé J. Intraneural injection during nerve stimulator-guided sciatic nerve block at the popliteal fossa. Br J Anaesth 2009; 102:855-61. [PMID: 19420006 DOI: 10.1093/bja/aep097] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exact location of the needle tip during nerve stimulation-guided peripheral nerve blocks is unknown. Using high-frequency ultrasound imaging, we tested the hypothesis that intraneural injection is common with nerve stimulator-guided sciatic nerve (SN) block in popliteal fossa. METHODS Forty-two patients scheduled for hallux valgus repair were studied. Sciatic block at the popliteal fossa was accomplished using nerve stimulation. When a motor response was elicited at <0.5 mA (2 Hz, 0.1 ms), 40 ml of local anaesthetic (LA) was injected. Using ultrasound (Titan, Sonosite, 5-10 MHz), the diameters and area of the SN were measured before and after the injection. The presence of nerve swelling and proximal or distal diffusion of LA were also assessed. Intraneural injection was defined as nerve area (NA) increase of > OR =15% and one or more additional ultrasonographic markers (nerve swelling, proximal-distal diffusion within epineural tissue). Clinical neurological evaluation was performed 1 week after the block. RESULTS Post-injection NA increase > OR =15% was seen in 32 (76%) patients [0.54 (SD 0.19) cm(-2) vs 0.76 (0.24) cm(-2); P<0.05]. Nerve swelling with fascicular separation was observed in 37 (88%) patients; proximal and distal diffusion of LA were present in six (14%) and 14 (38%) patients, respectively. Intraneural injection criteria were met in 28 (66%) patients. Greater NA increase was present in patients with fast block onset [61 (45) vs 25 (33)%; (Dif 35% 95% CI 61-9%); P<0.05]. No patient developed neurological complications. CONCLUSIONS Intraneural (subepineural) injection is a common occurrence after nerve stimulator-guided SN block at the popliteal fossa, yet it may not inevitably lead to neurological complications.
Collapse
Affiliation(s)
- X Sala Blanch
- Department of Anesthesiology, Hospital Clinic, Universitat de Barcelona, C/Villarroel 170, Barcelona 08036, Spain.
| | | | | | | | | | | | | |
Collapse
|
49
|
Maliakal T, Patel S, Hadzic A. Ultrasound guidance to facilitate low interscalene brachial plexus block in a patient with indwelling hemodialysis catheter. Can J Anaesth 2009; 56:551-2. [DOI: 10.1007/s12630-009-9102-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 04/09/2009] [Indexed: 11/28/2022] Open
|
50
|
Abstract
The American Society of Regional Anesthesia and Pain Medicine (ASRA) Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine includes an evidence- and expert opinion-based section on performing procedures on anesthetized or heavily sedated patients. This practice advisory is based on existing scientific literature, pathophysiological principles, and expert opinion. The advisory panel examined the ability of anesthetized or heavily sedated patients to recognize and report intravascular injection of local anesthetic or impending neurologic injury. The advisory panel also considered whether or not the ability to recognize and report symptoms could actually affect the occurrence of nerve injury or local anesthetic systemic toxicity. The advisory contains recommendations pertaining to both adult and pediatric patients.
Collapse
Affiliation(s)
- Christopher M Bernards
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA 98101-2756, USA.
| | | | | | | |
Collapse
|