8Audit of the analgesic efficacy of suprascapular and brachial plexus nerve blocks

Peripheral nerve blocks can be used for anesthesia, postoperative analgesia, diagnosis and treatment of chronic pain disorders. Skilful application of peripheral nerveblockade broadens the anesthesia provider's range of options in providing optimal anesthetic care. These techniques can be used in all age groups, with appropriate selection and sedation. Present prospective, randomized, double blinded study was conducted at Department of Anaesthesiology, SKMCH, Muzaffarpur, Bihar. Total Sixty consecutive adult patients undergoing upper limb orthopaedic surgeries under supraclavicular block were studied. The patients were drafted in the study after obtaining written informed consent from them. Patients divided in two groups : No statistically signicant difference in the demographic parameters and duration of surgery between the two groups was noted. We, therefore, conclude that addition of 8 mg dexamethasone to bupivacaine 0.25% solution in supraclavicular brachial plexus block. 1) Prolongs the duration of sensory and motor blockade. 2) Reduces the requirement of rescue analgesic in postoperative period. 3) Has no effect on the onset time of sensory and motor blockadc

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Refining a great idea: the consolidation of PECS I, PECS II and serratus blocks into a single thoracic fascial plane block, the SAP block

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-100745 ◽

2019 ◽

pp. rapm-2019-100745 ◽

Cited By ~ 2

Author(s):

Carlo D Franco ◽

Konstantin Inozemtsev

Keyword(s):

Brachial Plexus ◽

Chest Wall ◽

Mechanism Of Action ◽

Sensory Innervation ◽

Common Mechanism ◽

Nerve Blocks ◽

Intercostal Nerves ◽

Lateral Branches ◽

Fascial Plane Block ◽

Fascial Plane

The popularity of ultrasound-guided nerve blocks has impacted the practice of regional anesthesia in profound ways, improving some techniques and introducing new ones. Some of these new nerve blocks are based on the concept of fascial plane blocks, in which the local anesthetic is injected into a plane instead of around a specific nerve. Pectoralis muscles (PECS) and serratus blocks, most commonly used for post op analgesia after breast surgery, are good examples. Among the nerves targeted by PECS/serratus blocks are different branches of the brachial plexus that traditionally have been considered purely motor nerves. This unsubstantiated claim is a departure from accepted anatomical knowledge and challenges our understanding of the sensory innervation of the chest wall. The objective of this Daring Discourse is to look beyond the ability of PECS/serratus blocks to provide analgesia/anesthesia of the chest wall, to concentrate instead on understanding the mechanism of action of these blocks and, in the process, test the veracity of the claim. After a comprehensive review of the evidence we have concluded that (1) the traditional model of sensory innervation of the chest wall, which derives from the lateral branches of the upper intercostal nerves and does not include branches of the brachial plexus, is correct. (2) PECS/serratus blocks share the same mechanism of action, blocking the lateral branches of the upper intercostal nerves, and so their varied success is tied to their ability to reach them. This common mechanism agrees with the traditional innervation model. (3) A common mechanism of action supports the consolidation of PECS/serratus blocks into a single thoracic fascial plane block with a point of injection closer to the effector site. In a nod to transversus abdominus plane block, the original inspiration for PECS blocks, we propose naming this modified block, the serratus anterior plane block.

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Intraoperative Nerve Stimulation During Brachial Plexus Surgery: Comparison Between a Totally Disposable Nerve Stimulator and Nerve Stimulator Normally Used for Nerve Blocks

Plastic Surgery ◽

10.1177/2292550317716120 ◽

2017 ◽

Vol 25 (3) ◽

pp. 171-174

Author(s):

Ahmed Thallaj ◽

Wadha M. Alotaibi ◽

Tariq AlZahrani ◽

Abdulaziz S. Abaalkhail ◽

Amel A. F. El-Sayed ◽

...

Keyword(s):

Brachial Plexus ◽

Nerve Stimulation ◽

Ease Of Use ◽

Nerve Stimulator ◽

Nerve Blocks ◽

Group 2 ◽

Materials Used ◽

Disposable Device ◽

Brachial Plexus Surgery ◽

The Cost

Background: Intraoperative nerve stimulation is done routinely in brachial plexus and peripheral nerve surgery as well as in selective neurectomy in spastic patients. Objective: The current study compares the use of 2 different devices for nerve stimulation: a totally disposable nerve stimulator and a nerve stimulator used for nerve blocks by anesthetists. Methods: A retrospective study of 60 patients who underwent brachial plexus surgery: In 30 patients, we used the totally disposable nerve stimulator (group 1) and in another 30 patients, we used the anesthesia device (group 2). The cost of disposable materials used for nerve stimulation was calculated in each group. The same surgeon performed all operations, and he was asked to give his subjective opinion regarding the convenience and ease of use of the device in each group. Results: The main advantages of the totally disposable device are its placement totally within the sterile field, and it is operated by the surgeon without the need to communicate with the anesthetist. However, the totally disposable device had several major disadvantages when compared to the anesthesia device. Firstly, the disposable stimulator can only deliver 0.5, 1.0, and 2.0 mA stimuli, while the anesthesia device can deliver stimuli of 0.1 to 5 mA (in 0.1 mA increments). Secondly, the disposable stimulator frequently fails to operate during surgery, and this is not experienced with the anesthesia device. Finally, the cost of disposables is less using the anesthesia device. Conclusion: Our center has stopped using the disposable nerve stimulator in favour for the anesthesia device.

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Analgesic Efficacy of Nerve Blocks After Abdominoplasty: A Systematic Review

Aesthetic Surgery Journal ◽

10.1093/asj/sjz313 ◽

2019 ◽

Vol 40 (11) ◽

pp. 1208-1215 ◽

Cited By ~ 1

Author(s):

Peter M Vonu ◽

Paul Campbell ◽

Noah Prince ◽

Bruce A Mast

Keyword(s):

Systematic Review ◽

Rectus Sheath ◽

Analgesic Efficacy ◽

Postoperative Pain Management ◽

Opioid Consumption ◽

Transversus Abdominis ◽

Level Of Evidence ◽

Nerve Blocks ◽

Quadratus Lumborum ◽

Meta Analyses

Abstract Background A variety of regional nerve blocks have been utilized in abdominoplasty procedures, including transversus abdominis plane (TAP), intercostal, rectus sheath (RS), pararectus + ilioinguinal/iliohypogastric, quadratus lumborum, and paravertebral blocks. No consensus exists regarding the most effective nerve block modality in optimizing postprocedural comfort levels. Objectives The purpose of this systematic review was to explore the efficacy of the various abdominal nerve blocks employed in abdominoplasty surgery and to draw attention to any modality that may be superior in regards to effectiveness and/or administration. Methods Utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed to identify studies that have employed regional nerve blocks in abdominoplasty procedures. Opioid consumption, pain scores, time to ambulation, time in the recovery room, and time to first analgesia request were extracted when available. Results A total of 191 articles were reviewed, of which 8 met inclusion criteria. The nerve blocks represented included TAP, RS, pararectus + ilioinguinal/iliohypogastric, intercostal, and quadratus lumborum. All modalities were effective in reducing opioid consumption except quadratus lumborum. Conclusions TAP, RS, pararectus + ilioinguinal/iliohypogastric, and intercostal regional nerve blocks have been shown to optimize postoperative pain management in abdominoplasty procedures. The existing literature suggests that when studied against one another, TAP is more efficacious than RS and pararectus + ilioinguinal/iliohypogastric. When ultrasound guidance is unavailable, consideration should be given to TAP employing the direct visualization approach. Level of Evidence: 2

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COMPARISON OF FENTANYL AND DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A RANDOMIZED-DOUBLE BLIND PROSPECTIVE STUDY

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2016.v9i5.11928 ◽

2016 ◽

Vol 9 (5) ◽

pp. 74 ◽

Cited By ~ 1

Author(s):

Daisy Karan ◽

Swastika Swaro ◽

Swarna Banerjee

Keyword(s):

Brachial Plexus ◽

Upper Limb ◽

Brachial Plexus Block ◽

Nerve Blocks ◽

Double Blind ◽

Rescue Analgesia ◽

Sensory Blockade ◽

Significant Difference ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

ABSTRACTObjectives: Supraclavicular block of brachial plexus provides complete and reliable anesthesia for upper limb surgeries. Using adjuvant to localanesthetics, blocks can be prolonged to long durations. Peripheral nerve blocks thus help in avoiding the hazards of general anesthesia. We comparedthe sensory blockade, motor blockade, and duration of analgesia with the addition of fentanyl or dexmedetomidine to bupivacaine for supraclavicularbrachial plexus block.Methods: A total of 50 American Society of Anesthesiologist’s Physical Status I and II patients scheduled for elective upper limb surgeries undersupraclavicular brachial plexus block were divided into two equal groups in a randomized double-blinded fashion. Group BF received 30 mlbupivacaine with fentanyl 50 µg and Group BD received 30 ml bupivacaine with dexmedetomidine 50 µg. The characteristics for anesthesia andanalgesia were assessed in both groups.Results: Duration of sensory and motor block was 363.4±38.36 minutes and 357±36.77 minutes, respectively, in Group BF while it was452.96±77.12 minutes and 441.52±48.46 minutes in Group BD. There was a statistically significant difference in onset of sensory and motorblock between the two groups. The duration of analgesia (time to requirement of rescue analgesia) in Group BD was longer than in Group BF(471.44±65.88 minutes vs. 366.48±38.02 minutes) with (p<0.0001). There were minimum hemodynamic disturbances and side effects in any groupexcept for Grade 3 sedation score which was more in Group BD.Conclusion: Dexmedetomidine, when added to bupivacaine in supraclavicular brachial plexus block, enhanced the duration of sensory and motorblock and also the duration of analgesia, more than when fentanyl was added to bupivacaine.Keywords: Fentanyl, Dexmedetomidine, Bupivacaine, Supraclavicular brachial block.

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Distribution of a lidocaine-methylene blue solution staining in brachial plexus, lumbar plexus and sciatic nerve blocks in the dog

Veterinary Anaesthesia and Analgesia ◽

10.1111/j.1467-2995.2007.00390.x ◽

2008 ◽

Vol 35 (4) ◽

pp. 348-354 ◽

Cited By ~ 72

Author(s):

Luis Campoy ◽

Manuel Martin-Flores ◽

Andrea L. Looney ◽

Hollis N. Erb ◽

John W. Ludders ◽

...

Keyword(s):

Methylene Blue ◽

Sciatic Nerve ◽

Brachial Plexus ◽

Lumbar Plexus ◽

Methylene Blue Solution ◽

Nerve Blocks ◽

Blue Solution

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Brachial Plexus Anatomy: Normal and Variant

The Scientific World JOURNAL ◽

10.1100/tsw.2009.39 ◽

2009 ◽

Vol 9 ◽

pp. 300-312 ◽

Cited By ~ 36

Author(s):

Steven L. Orebaugh ◽

Brian A. Williams

Keyword(s):

Brachial Plexus ◽

Relevant Literature ◽

Axillary Nerve ◽

Cochrane Library ◽

Anatomic Variations ◽

Normal Anatomy ◽

Nerve Blocks ◽

Mesh Terms ◽

Brachial Plexus Blockade ◽

Real Time Ultrasonography

Effective brachial plexus blockade requires a thorough understanding of the anatomy of the plexus, as well as an appreciation of anatomic variations that may occur. This review summarizes relevant anatomy of the plexus, along with variations and anomalies that may affect nerve blocks conducted at these levels. The Medline, Cochrane Library, and PubMed electronic databases were searched in order to compile reports related to the anatomy of the brachial plexus using the following free terms: "brachial plexus", "median nerve", "ulnar nerve", "radial nerve", "axillary nerve", and "musculocutanous nerve". Each of these was then paired with the MESH terms "anatomy", "nerve block", "anomaly", "variation", and "ultrasound". Resulting articles were hand searched for additional relevant literature. A total of 68 searches were conducted, with a total of 377 possible articles for inclusion. Of these, 57 were found to provide substantive information for this review. The normal anatomy of the brachial plexus is briefly reviewed, with an emphasis on those features revealed by use of imaging technologies. Anomalies of the anatomy that might affect the conduct of the various brachial plexus blocks are noted. Brachial plexus blockade has been effectively utilized as a component of anesthesia for upper extremity surgery for a century. Over that period, our understanding of anatomy and its variations has improved significantly. The ability to explore anatomy at the bedside, with real-time ultrasonography, has improved our appreciation of brachial plexus anatomy as well.

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