The Place of Peripheral Nerve Blocks in Reconstructive Hand Surgery

HAND ◽  
1977 ◽  
Vol os-9 (2) ◽  
pp. 157-159 ◽  
Author(s):  
W. Bruce Conolly ◽  
F. R. Berry
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Hand Surgery ◽  
Tendon Graft ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Reconstructive Operations

Seventy reconstructive operations on the hand were done with the patient's full co-operation during the procedure. Anæsthesia was provided by a peripheral nerve block at the level of the wrist or the metacarpo-phalangeal joint. This technique enabled the surgeon to estimate the required extent of such operations as tenolysis, arthrolysis, arthroplasty, and tendon graft. It also helped the patient to appreciate the movement he could achieve post-operatively.

scholarly journals The Use of Long Acting Opioids to Prevent Rebound Pain Following Peripheral Nerve Blocks for Outpatient Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Leah Herzog ◽  
Sylvia H. Wilson ◽  
Christopher E. Gross
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Pain Medication ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Pain Scores ◽  
Ankle Surgery ◽  
Patient Reported ◽  
Long Acting

Category: Ankle; Bunion Introduction/Purpose: Peripheral nerve blocks have become an integral part of orthopedic surgery to assist with postoperative pain. However, 40% of patients who undergo a peripheral nerve block will experience rebound pain, which in turn, long-acting narcotics may be able to block. Unfortunately, this rebound pain can cancel out the potential benefits of decreased opioid medication use. Therefore, this study seeks to compare the difference in patient reported pain scores in those patients whom received long-acting opioid pain medication and those who did not. Methods: This is a retrospective review of patient-reported pain scores for 96 patients who underwent a peripheral nerve block for outpatient foot and ankle surgery. 48 patients either received three days of long-acting opioids or did not. Each patient was asked to fill out and return a pain diary as well as fill out a pain catastrophizing survey (PCS) at their postoperative appointment. The pain diary discussed their Visual Analogue Scale pain scores, amount of pain medication, and time they took the medicine. This data was then collected and compared via paired student t-tests for evaluation of significance. Results: Pain diaries were completed by 69 patients (72%). There were no significant differences between those comorbidities, types of procedures, age, or BMI between the groups. Mean postoperative pain scores did not differ between patients that did and did not receive postoperative extended release opioid medications (p = 0.226). Mean opioid consumption did not differ between groups (p = 0.945). There were no correlations between daily reported pain scores or the postoperative day with the highest pain score for those who received long acting opioid pain medication versus those who did not (r=0.336, p=0.550). Conclusion: Rebound pain is a difficult potential side effect of peripheral nerve blocks that currently does not have a preventative measure. This study was an attempted effort to help eliminate rebound pain, but there did not appear to be a significant benefit to adding long-acting opioid pain medication in addition to the peripheral nerve block and short-acting pain medication

scholarly journals Does Rebound Pain after Peripheral Nerve Block for Orthopedic Surgery Impact Postoperative Analgesia and Opioid Consumption? A Narrative Review

2019 ◽  
Vol 16 (18) ◽  
pp. 3257 ◽  
Author(s):  
Olufunke Dada ◽  
Alicia Gonzalez Zacarias ◽  
Corinna Ongaigui ◽  
Marco Echeverria-Villalobos ◽  
Michael Kushelev ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Opioid Consumption ◽  
Orthopedic Procedures ◽  
Negative Consequences ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
The Impact

Regional anesthesia has been considered a great tool for maximizing post-operative pain control while minimizing opioid consumption. Post-operative rebound pain, characterized by hyperalgesia after the peripheral nerve block, can however diminish or negate the overall benefit of this modality due to a counter-productive increase in opioid consumption once the block wears off. We reviewed published literature describing pathophysiology and occurrence of rebound pain after peripheral nerve blocks in patients undergoing orthopedic procedures. A search of relevant keywords was performed using PubMed, EMBASE, and Web of Science. Twenty-eight articles (n = 28) were included in our review. Perioperative considerations for peripheral nerve blocks and other alternatives used for postoperative pain management in patients undergoing orthopedic surgeries were discussed. Multimodal strategies including preemptive analgesia before the block wears off, intra-articular or intravenous anti-inflammatory medications, and use of adjuvants in nerve block solutions may reduce the burden of rebound pain. Additionally, patient education regarding the possibility of rebound pain is paramount to ensure appropriate use of prescribed pre-emptive analgesics and establish appropriate expectations of minimized opioid requirements. Understanding the impact of rebound pain and strategies to prevent it is integral to effective utilization of regional anesthesia to reduce negative consequences associated with long-term opioid consumption.

Lack of July effect in the utilization of neuraxial and peripheral nerve block in US teaching hospitals: a retrospective analysis

2020 ◽  
Vol 45 (5) ◽  
pp. 357-361
Author(s):  
Sang Jo Kim ◽  
Lauren Wilson ◽  
Jiabin Liu ◽  
David H Kim ◽  
Megan Fiasconaro ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Neuraxial Anesthesia ◽  
House Staff ◽  
Teaching Hospitals ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Opioid Prescribing ◽  
July Effect

BackgroundGiven the steep learning curve for neuraxial and peripheral nerve blocks, utilization of general anesthesia may increase as new house staff begin their residency programs. We sought to determine whether “July effect” affects the utilization of neuraxial anesthesia, peripheral nerve blocks, and opioid prescribing for lower extremity total joint arthroplasties (TJA) in July compared with June in teaching and non-teaching hospitals.MethodsNeuraxial anesthesia, peripheral nerve block use, and opioid prescribing trends were assessed using the Premier database (2006–2016). Analyses were conducted separately for teaching and non-teaching hospitals. Differences in proportions were evaluated via χ2 test, while differences in opioid prescribing were analyzed via Wilcoxon rank-sum tests.ResultsA total of 1 723 256 TJA procedures were identified. The overall proportion of neuraxial anesthesia use in teaching hospitals was 14.4% in both June and July (p=0.940). No significant changes in neuraxial use were seen in non-teaching hospitals (24.5% vs 24.9%; p=0.052). Peripheral nerve block utilization rates did not differ in both teaching (15.4% vs 15.3%; p=0.714) and non-teaching hospitals (10.7% vs 10.5%; p=0.323). Overall median opioid prescribing at teaching hospitals changed modestly from 262.5 oral morphine equivalents (OME) in June to 260 in July (p=0.026) while median opioid prescribing remained at a constant value of 255 OME at non-teaching hospitals (p=0.893).ConclusionUtilization of neuraxial and regional anesthesia techniques was not affected during the initial transition period of new house staff in US teaching institutions. It is feasible that enough resources are available in the system to accommodate periods of turnover and maintain levels of regional anesthetic care including additional attending anesthesiologist oversight.

Continuous Peripheral Nerve Blocks at Home for Treatment of Recurrent Complex Regional Pain Syndrome I in Children

2005 ◽  
Vol 102 (2) ◽  
pp. 387-391 ◽  
Author(s):  
Christophe Dadure ◽  
Frederic Motais ◽  
Christine Ricard ◽  
Olivier Raux ◽  
Rachel Troncin ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Complex Regional Pain Syndrome ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Pain Syndrome ◽  
Nerve Blocks ◽  
Rescue Analgesia ◽  
Peripheral Nerve Blocks ◽  
Children And Parents ◽  
Bier Block

Background Recurrent complex regional pain syndrome I is not rare in the pediatric population. The authors conducted this study to evaluate the efficacy of continuous peripheral nerve blocks with elastomeric disposable pumps associated with initial Bier blocks for the treatment of recurrent complex regional pain syndrome I in children. Methods After parental informed consent, 13 children who did not respond to conventional complex regional pain syndrome treatment were included (mean age, 13 yr; range, 9-16 yr). After general anesthesia, peripheral nerve block was performed using 0.5 ml/kg lidocaine, 1%, with epinephrine and 0.5% ropivacaine injected in the peripheral nerve block catheter. Then, a 20-min Bier block was performed using a tourniquet and 0.2 ml/kg lidocaine, 1%; 3 ml/kg hydroxyethyl starch 130/06; and 5 mg/kg buflomedil injected intravenously. A solution of 0.1 ml . kg . h continuous ropivacaine, 0.2%, was infused through the catheter using an elastomeric pump for 96 h. Need for rescue analgesia, occurrence of side effects, and status of motor and sensory block were recorded at hours 1, 6, 12, 24, 48, 72, and 96. Children and parents completed a satisfaction assessment. All of the children had follow-up visits after 2 months. Results Postoperative analgesia was excellent. The median pain score was 0 for each period studied. Motor blockade was minimal before 12 h (median, 1) and absent thereafter. One child needed rescue analgesia. All children were able to walk easily after the initial 24-h period (walking score, > 4). Children and parents were all satisfied. Children returned home under parental surveillance beginning in the 24th hour. Neither peripheral nerve block nor Bier block caused side effects. After 2 months, none of the children exhibited any clinical symptom of recurrent complex regional pain syndrome. Conclusion Ambulatory continuous peripheral nerve block associated with an initial Bier block seems to be a significant and novel contribution to treat recurrent pediatric complex regional pain syndrome I. It allows complete pain relief, early mobilization, and rapid return home, representing a psychological advantage for these children.

Continuous Peripheral Nerve Blocks

2019 ◽  
pp. 555-567
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks

This chapter reviews the use of peripheral nerve block catheters in regional anesthesia.

Invasive placebos in research on peripheral nerve blocks: a follow-up study

2021 ◽  
pp. rapm-2021-102474
Author(s):  
Sarah Laing ◽  
Dana L Bolt ◽  
Laura L Burgoyne ◽  
Cormac J Fahy ◽  
Pauline B Wake ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Original Study ◽  
Body Region ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Non Invasive ◽  
Randomized Controlled Studies ◽  
Study Participants

IntroductionThe Serious Harm and Morbidity “SHAM” grading system has previously been proposed to categorize the risks associated with the use of invasive placebos in peripheral nerve block research. SHAM grades range from 0 (no potential complications, eg, using standard analgesia techniques as a comparator) through to 4 (risk of major complications, eg, performing a sub-Tenon’s block and injecting normal saline). A study in 2011 found that 52% of studies of peripheral nerve blocks had SHAM grades of 3 or more.MethodsWe repeated the original study by allocating SHAM grades to randomized controlled studies of peripheral nerve blocks published in English over a 22-month period. Documentation was made of the number of study participants, age, number of controls, body region, adverse events due to invasive placebos and any discussion regarding the ethics of using invasive placebos. We compared the proportion of studies with SHAM grades of 3 or more with the original study.ResultsIn this current study, 114 studies fulfilled the inclusion criteria, 5 pediatric and 109 adult. The SHAM grade was ≥3 in 38 studies (33.3%), with 1494 patients in these control groups collectively. Several studies discussed their reasons for choosing a non-invasive placebo. No pediatric studies had a SHAM grade of ≥3.ConclusionsThe use of invasive placebos that may be associated with serious risks in peripheral nerve block research has decreased in contemporary peripheral nerve block research.

Time Sequence of Sensory Changes after Upper Extremity Block

2004 ◽  
Vol 101 (1) ◽  
pp. 162-168 ◽  
Author(s):  
Xavier Paqueron ◽  
Marc E. Gentili ◽  
Jean Claude Willer ◽  
Pierre Coriat ◽  
Bruno Riou
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Clinical Test ◽  
Sensory Impairment ◽  
Sensory Testing ◽  
Early Assessment ◽  
Sensory Assessment ◽  
Nerve Blocks ◽  
Sensory Fibers

Background Sensory assessment to estimate spread and effectiveness of a peripheral nerve block is difficult because no clinical test is specific for small sensory fibers. Occurrence of a swelling illusion (SI) during a peripheral nerve block corresponds to the impairment of small sensory fibers. The authors investigated the usefulness of SI in predicting successful peripheral nerve block by assessing the temporospatial correlation between progression of sensory impairment in cutaneous distributions anesthetized and localization of SI during peripheral nerve block installation. Methods Interscalene, infracoracoid, or sciatic nerve blocks were performed using a nerve stimulator and 1.5% mepivacaine in 53 patients, with a total of 201 nerves to be anesthetized. Pinprick, cold, warm, touch, and proprioception were assessed every 3 min, while patients were asked to describe their perception of size and shape of their anesthetized limb and localization of these illusions. Data are presented as mean +/- SD and percentage (95% confidence interval). Results Failure occurred in 12 cutaneous distributions out of a total of 201 theoretically blocked nerves. SI appeared earlier than warmth impairment (4.3 +/- 2.7 vs. 6.2 +/- 2.0 min; P < 0.05), always corresponding to successfully anesthetized cutaneous distributions, with the exception of 1 patient, who developed SI in 2 cutaneous distributions while sensory testing indicated failure in 1 distribution. SI successfully predicted the blockade of a cutaneous distribution with a sensitivity of 1.00 (0.98-1.00), a specificity of 0.92 (0.65-0.99), and an accuracy of 0.99 (0.97-1.00). Conclusions Swelling illusion may provide an early assessment of the success of a peripheral nerve block in unsedated patients.

scholarly journals Continuous Versus Single-Injection Peripheral Nerve Blocks: A Prospective Cohort Study Comparing Procedural Time and Estimated Personnel Cost

2015 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Brendan Carvalho ◽  
Romy D. Yun ◽  
Edward R. Mariano
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Single Injection ◽  
Clinical Care ◽  
Personnel Cost ◽  
Additional Time ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Physician Time

Background and Objectives: Continuous peripheral nerve blocks (CPNB) provide many additional benefits compared to single-injection peripheral nerve blocks (SPNB). However, the time and costs associated with CPNB provision have not been previously considered. The objective of this study was to compare the time required and estimated personnel costs associated with CPNB and SPNB. Methods: This IRB-exempt observational study involved provision of preoperative regional anesthesia procedures in a “block room” model by a dedicated team during routine clinical care. The primary outcome, the time to perform ultrasound-guided popliteal-sciatic blocks, was recorded prospectively. This time measurement was broken down into individual tasks: time to place monitors, prepare the equipment, scan and identify the target, perform the block, and clean up post-procedure. For peripheral nerve block catheters, time to insert, locate, and secure the catheter was also recorded. Cost estimates for physician time were determined using published national mean hourly wages. Results: Time measurements were recorded for 24 nerve block procedures (12 CPNB and 12 SPNB). The median (IQR; range) total time (seconds) taken to perform blocks was 1132 (1083-1290; 1060-1623) for CPNB versus 505 (409-589; 368-635) for SPNB (Table 1; p<0.001). The median (IQR) cost attributed to physician time during block performance was $35.20 ($33.66-$40.11) and $15.69 ($12.73-$18.32) for CPNB and SPNB, respectively. Conclusion: CPNB requires approximately 10 more minutes per procedure to perform when compared to SPNB. This additional time should be considered along with potential patient benefits and available resources when developing a regional anesthesia and acute pain medicine service.

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