Distal Peripheral Nerve Blocks in the Forearm as an Alternative to Proximal Brachial Plexus Blockade in Patients Undergoing Hand Surgery: A Prospective and Randomized Pilot Study

2016 ◽  
Vol 41 (10) ◽  
pp. 969-977 ◽  
Author(s):  
José R. Soberón ◽  
Joseph W. Crookshank ◽  
Bobby D. Nossaman ◽  
Clint E. Elliott ◽  
Leslie E. Sisco-Wise ◽  
...  
Keyword(s):  
Pilot Study ◽  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Hand Surgery ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Brachial Plexus Blockade

scholarly journals Effect of Anaesthesiologists’ Experience on Preferred Technique and Volume of Local Anaesthetic Administered for Brachial Plexus Nerve Block: A Retrospective Observational Analysis

2021 ◽  
Author(s):  
Depinder Kaur ◽  
Reena Mahajan ◽  
Shiv Kumar Singh ◽  
Suchitra Malhotra
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Failure Rate ◽  
Nerve Block ◽  
Local Anaesthetic ◽  
Block Group ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Group A ◽  
Group B

Introduction: Faculty and Residents are trained in peripheral nerve blocks guided by blind technique, Peripheral Neuro Stimulator (PNS) or Ultrasound (USG) guided technique. But due to unavailability of USG machine in all institutes and requiring special training, techniques used for peripheral nerve blocks vary from institute to institute. Aim: To analyse the effect of anaesthesiologists’ experience on preferred technique and Local Anaesthetic (LA) volume used for brachial plexus nerve block retrospectively. Materials and Methods: In this retrospective observational study, 129 adults American Society of Anesthesiologists (ASA) grade I and II patients requiring brachial plexus nerve block for upper limb orthopaedic surgical anaesthesia for both elective and emergency surgery were divided into three groups for each year depending on technique for nerve block used. Group A: Received USG guided (Micromaxx Sonosite Inc, USA) brachial plexus nerve block. Group B: Received peripheral nerve stimulator (Inmed) guided brachial plexus nerve block. Group C: Received brachial plexus nerve block by traditional anatomical landmark based paraesthesia elicitation blind technique. Patients with inadequate surgical analgesia were given general anaesthesia and were categorised as failure rate. Year wise demographic data, type of technique used for giving brachial plexus nerve block, volume of drug used, failure rate, complications observed were collected and analysed by Student’s t-test and Chi-square test. Results: USG guided technique was the most prefered technique in both years (57.6%, n=38 in year 2018 and 49.2%, n=31 in year 2019). In remaining nearly half of the patients PNS and blind technique was used (PNS 24.2%, n=16 in year 2018 and 20.6%, n=13 in year 2019; blind technique 18.2%, n=12 in year 2018 and 30.2%, n=19 in year 2019). Significantly, less volume of LA drug (mL) was used in group A in year 2019 (16.43±6.07) than in year 2018 (22.34±4.75) (p<0.001). Failure rate in group A in year 2019 (3.2%) was significantly less than in year 2018 (5.2%), but the difference was insignificant in all three groups. In group A, no complications were observed in year 2019 while one incidence of hemidiaphragm paralysis was observed in year 2018, while in group B and C, complications were observed in both years. Conclusion: USG guided nerve block was the most preferred technique for nerve block in the study institute. In 24 months observation period, with increasing experience with USG there was significant increase in success rate and decrease in the volume of LA administered and complications.

Optical Detection of the Brachial Plexus for Peripheral Nerve Blocks

2011 ◽  
Vol 36 (4) ◽  
pp. 350-357 ◽  
Author(s):  
Marcus Brynolf ◽  
Micha Sommer ◽  
Adrien E. Desjardins ◽  
Marjolein van der Voort ◽  
Stefan Roggeveen ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Optical Detection ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks

scholarly journals Treating Intractable Phantom Limb Pain with Ambulatory Continuous Peripheral Nerve Blocks: A Pilot Study

Pain Medicine ◽  
2013 ◽  
Vol 14 (6) ◽  
pp. 935-942 ◽  
Author(s):  
Brian M. Ilfeld ◽  
Tobias Moeller-Bertram ◽  
Steven R. Hanling ◽  
Kyle Tokarz ◽  
Edward R. Mariano ◽  
...  
Keyword(s):  
Pilot Study ◽  
Peripheral Nerve ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Pain ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks

scholarly journals Brachial Plexus Blockade Causes Subclinical Neuropathy

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 50-54 ◽  
Author(s):  
Donato J. Perretta ◽  
Matthew Gotlin ◽  
Kenneth Brock ◽  
Nader Paksima ◽  
Michael B. Gottschalk ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Statistical Significance ◽  
Hand Surgery ◽  
Block Group ◽  
Short Term ◽  
Nerve Blocks ◽  
Subclinical Neuropathy ◽  
Brachial Plexus Blockade ◽  
Group A

Background: The objective of this study is to determine subclinical changes in hand sensation after brachial plexus blocks used for hand surgery procedures. We used Semmes-Weinstein monofilament testing to detect these changes. We hypothesized that patients undergoing brachial plexus nerve blocks would have postoperative subclinical neuropathy detected by monofilament testing when compared with controls. Methods: In total, 115 hand surgery adult patients were prospectively enrolled in this study. All patients undergoing nerve-related procedures were excluded as well as any patients with preoperative clinically apparent nerve deficits. Eighty-four patients underwent brachial plexus blockade preoperatively, and 31 patients underwent general anesthesia (GA). Semmes-Weinstein monofilament testing of the hand was performed preoperatively on both the operative and nonoperative extremities and postoperatively at a mean of 11 days on both hands. Preoperative and postoperative monofilament testing scores were compared between the block hand and the nonoperated hand of the same patient, as well as between the block hands and the GA-operated hands. Results: There were no recorded clinically relevant neurologic complications in the block group or GA group. A statistically significant decrease in sensation in postoperative testing in the operated block hand compared with the nonoperated hand was noted. When comparing the operated block hand with the operated GA hand, there was a decrease in postoperative sensation in the operated block hand that did not reach statistical significance. Conclusions: Brachial plexus blockade causes subtle subclinical decreases in sensibility at short-term follow-up, without any clinically relevant manifestations.

scholarly journals A Triple-Masked, Randomized Controlled Trial Comparing Ultrasound-Guided Brachial Plexus and Distal Peripheral Nerve Block Anesthesia for Outpatient Hand Surgery

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Nicholas C. K. Lam ◽  
Matthew Charles ◽  
Deana Mercer ◽  
Codruta Soneru ◽  
Jennifer Dillow ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Motor Function ◽  
Brachial Plexus Block ◽  
Controlled Trial ◽  
Hand Surgery ◽  
Strength Loss ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Plexus Block

Background. For hand surgery, brachial plexus blocks provide effective anesthesia but produce undesirable numbness. We hypothesized that distal peripheral nerve blocks will better preserve motor function while providing effective anesthesia.Methods. Adult subjects who were scheduled for elective ambulatory hand surgery under regional anesthesia and sedation were recruited and randomly assigned to receive ultrasound-guided supraclavicular brachial plexus block or distal block of the ulnar and median nerves. Each subject received 15 mL of 1.5% mepivacaine at the assigned location with 15 mL of normal saline injected in the alternate block location. The primary outcome (change in baseline grip strength measured by a hydraulic dynamometer) was tested before the block and prior to discharge. Subject satisfaction data were collected the day after surgery.Results. Fourteen subjects were enrolled. Median (interquartile range [IQR]) strength loss in the distal group was 21.4% (14.3, 47.8%), while all subjects in the supraclavicular group lost 100% of their preoperative strength,P= 0.001. Subjects in the distal group reported greater satisfaction with their block procedures on the day after surgery,P= 0.012.Conclusion. Distal nerve blocks better preserve motor function without negatively affecting quality of anesthesia, leading to increased patient satisfaction, when compared to brachial plexus block.

scholarly journals A comparative study of Bupivacaine 0.5% versus Ropivacaine 0.5% for supraclavicular brachial plexus block (subclavian perivascular approach only) in ASA II,III patients

2016 ◽  
Vol 2 (10) ◽  
pp. 173
Author(s):  
Natarajan Pooranan ◽  
Dhanasekaran C
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Local Anaesthetic ◽  
Brachial Plexus Block ◽  
Nerve Blocks ◽  
Sensory Blockade ◽  
Peripheral Nerve Blocks ◽  
Supraclavicular Brachial Plexus Block ◽  
Long Acting ◽  
Plexus Block

Peripheral nerve blocks have become important in clinical practice because of their role in post-operative pain relief, shortening of patient recovery time & avoiding risks and adverse effects of general anaesthesia. Bupivacaine is a long acting local anaesthetic. Due to its long duration of action and combined with its high quality sensory blockade compared to motor blockade it has been the most commonly used local anaesthetic for peripheral nerve blocks. Ropivacaine is a newer, long acting local anaesthetic whose neuronal blocking potential used in peripheral nerve blockade seems to be equal or superior to bupivacaine. Studies show that it has significantly greater safety margin over bupivacaine. Hence here is an attempt through the study to compare bupivacaine with ropivacaine in supraclavicular brachial plexus block in ASA II&III patients.

Continuous Peripheral Nerve Blocks for Early Active Mobilization after Hand Surgery: Four Case Reports

2018 ◽  
Vol 23 (03) ◽  
pp. 419-423
Author(s):  
Takanobu Otsuka ◽  
Hideki Okamoto ◽  
Jun Mizutani ◽  
Hideyuki Goto ◽  
Isato Sekiya
Keyword(s):  
Peripheral Nerve ◽  
Case Reports ◽  
Infusion Pump ◽  
Hand Surgery ◽  
Scar Tissue ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Catheter Tip ◽  
Active Mobilization ◽  
Vas Scores

Early active mobilization after hand surgery is extremely important for preventing scar tissue and adhesion. We examined four patients for whom continuous peripheral nerve blocks (CPNB) were used during and after hand surgery. This method was used for three median nerves and one ulnar nerve. A 2-cm incision was made at distal one-third of the forearm with local analgesia. The catheter tip was placed in the distal one-fourth of the forearm, and the hand surgery was begun. Early active mobilization and the self-rehabilitation exercise started immediately after the operation. The VAS scores during exercise were 0–2 (mean: 1.3); pain was controlled sufficiently. Regarding ROM, excellent results were obtained for tenolysis, with good results for arthrolysis. No infection or postoperative nerve compression was found. This method, using CPNB with a portable infusion pump, is effective and safe for use at home for postoperative pain control.

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