Neuraxial and Peripheral Nerve Block Placement in Patients with Anatomical Anomalies

Author(s):  
Donna-Ann Thomas ◽  
Sible Antony ◽  
David Sum ◽  
Abbas Asgerally

This case focuses on administering nerve stimulators through multiple injections in the limbs by asking the question: For peripheral nerve blocks performed using the multiple injection technique with a nerve stimulator, what are the failure rate, patient acceptance, effective volume of local anesthetic solution, and incidence of neurologic complications? Use of the multiple injection technique with a nerve stimulator during peripheral nerve block placement has a high success rate, with <2% incidence of transient neurologic complications. Elevated tourniquet inflation pressure was associated with an increased risk for transient nerve injury. However, only 74% of patients would request the same anesthetic procedure if they underwent another surgery, mainly owing to discomfort during peripheral nerve block placement.


2021 ◽  
pp. 0310057X2097240
Author(s):  
Anthony D Hade ◽  
Satomi Okano ◽  
Anita Pelecanos ◽  
Adrian Chin

Peripheral nerve blocks can provide surgical anaesthesia as well as excellent postoperative analgesia. When questioned postoperatively, however, some patients report low levels of satisfaction with their nerve block experience. At our hospital, patients undergoing regional anaesthesia have their patient characteristics, block characteristics and postoperative feedback routinely recorded in a block registry. We analysed data from 979 consecutive patients undergoing peripheral nerve block for orthopaedic surgery to identify factors associated with low levels of patient satisfaction. The primary outcome was patient satisfaction with their peripheral nerve block (scale 1–5: 4–5 is ‘satisfied’, 1–3 is ‘not satisfied’). Eighty-nine percent (871/979) of patients reported being ‘satisfied’ with their block. Factors negatively associated with patient satisfaction were rebound pain (adjusted odds ratio (aOR) 0.19, 95% confidence interval (CI) 0.04 to 0.85 for moderate rebound pain; aOR 0.11, 95% CI 0.03 to 0.48 for severe rebound pain), discomfort during the block (aOR 0.37, 95% CI 0.16 to 0.82 for moderate discomfort; aOR 0.19, 95% CI 0.05 to 0.76 for severe discomfort) and pain in the post-anaesthesia care unit (aOR 0.30, 95% CI 0.17 to 0.55 for pain ≥8/10). Only 24% (26/108) of patients who reported being ‘not satisfied’ stated that they would be unwilling to undergo a hypothetical future nerve block. Rebound pain of at least moderate intensity, procedural discomfort of at least moderate intensity and severe pain in the post-anaesthesia care unit are all negatively associated with patient satisfaction. Of these factors, rebound pain occurs most frequently, being present in 52% (403/777) of our respondents.


2021 ◽  
Vol 61 (5) ◽  
pp. 574-580
Author(s):  
Nicole M. Duggan ◽  
Arun Nagdev ◽  
Bryan D. Hayes ◽  
Hamid Shokoohi ◽  
Lauren A. Selame ◽  
...  

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