scholarly journals A randomized trial to determine the minimum effective lidocaine volume for median nerve block using hydrodissection

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Eric Dufour ◽  
Souhail Jaziri ◽  
Marie Alice Novillo ◽  
Lila Aubert ◽  
Anne Chambon ◽  
...  
Keyword(s):  
Median Nerve ◽  
Nerve Block ◽  
Index Finger ◽  
Randomized Study ◽  
Onset Time ◽  
Hand Surgery ◽  
Ultrasound Guided ◽  
Anatomical Structures ◽  
Perineural Injection ◽  
Sequential Allocation

AbstractUltrasound-guided hydrodissection with 5% dextrose in water (DW5) creates a peri-nervous compartment, separating the nerve from the neighboring anatomical structures. The aim of this randomized study was to determine the minimum volume of lidocaine 2% with epinephrine 1:200,000 required when using this technique to achieve an effective median nerve block at the elbow in 95% of patients (MEAV95). Fifty-two patients scheduled for elective hand surgery received an ultrasound-guided circumferential perineural injection of 4 ml DW5 and an injection of local anesthetic (LA) following a biased coin up-and-down sequential allocation method. A successful block was defined as a light touch completely suppressed on the two distal phalanges of the index finger within a 30-min evaluation period. The MEAV95 of lidocaine 2% with epinephrine was 4 ml [IQR 3.5–4.0]. Successful median nerve block was obtained in 38 cases (82.6%) with median onset time of 20.0 [10.0–21.2] minutes (95% CI 15–20). The analgesia duration was 248 [208–286] minutes (95% CI 222–276). Using an ultrasound-guided hydrodissection technique with DW5, the MEAV95 to block the median nerve at the elbow with 2% lidocaine with epinephrine was 4 ml [IQR 3.5–4.0]. This volume is close to that usually recommended in clinical practice.Trial registration clinicaltrials.gov. NCT02438657, Date of registration: May 8, 2015.

The Use of a Selective Peripheral Median Nerve Block for Pain-Free Early Active Motion After Hand Surgery

2006 ◽  
Vol 31 (5) ◽  
pp. 857-859 ◽  
Author(s):  
Coralien L. Broekhuysen ◽  
Maarten R. Fechner ◽  
Hans E.M. Kerkkamp
Keyword(s):  
Median Nerve ◽  
Nerve Block ◽  
Hand Surgery ◽  
Active Motion

scholarly journals Ultrasound Guided Axillary Brachial Plexus Block Versus Supraclavicular Block In Emergency Crushed Hand Patients : A Comparative Study

2018 ◽  
Vol 12 (1) ◽  
pp. 34-41
Author(s):  
Rania Maher Hussien ◽  
Dalia Ahmed Ibrahim
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Hand Surgery ◽  
Good Alternative ◽  
Ultrasound Guided ◽  
Performance Time ◽  
Needle Pass ◽  
Supraclavicular Block ◽  
Plexus Block

Background: The current study focusses on ultrasound guided Brachial Plexus Block (BPB) which plays an important role in patients with hand trauma either in pain control or for surgical intervention. The brachial plexus can be blocked by several techniques but the most commonly used are the Supraclavicular (SCB) and Axillary (AXB) blocks. Objective: To compare the two techniques with regards to the performance time, needling time, anesthesia-related time, block-related complications, number of needle pass and block related pain. Methods: After approval of the ethical committee and obtaining a written informed consent from patients, this prospective, randomized, interventional double-blinded study was done to patients undergoing emergency crushed hand surgery. 80 patients were allocated randomly into two equal groups. Under ultrasound guidance, the SCB and AXB were done for the two groups, respectively. The needling time, performance time, anesthesia-related time, onset time, number of 1st needle pass in each group and block related complications were noted. Statistical Analysis: Data were analysed using the Statistical Package for Social Science (IBM SPSS) version 23 SPSS. Results: Longer needling, performance, anesthesia-related time in the AXB group than SCB and less complications have occurred with AXB than SCB group. Conclusion: Axillary block of brachial plexus is a good alternative to Supraclavicular block in emergency crushed hand surgery and the choice is made according to the requirement of each case.

scholarly journals Ultrasound-Guided Pudendal Nerve Block Combined with Propofol Deep Sedation versus Spinal Anesthesia for Hemorrhoidectomy: A Prospective Randomized Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Jian He ◽  
Lei Zhang ◽  
Dong L. Li ◽  
Wan Y. He ◽  
Qing M. Xiong ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Spinal Anesthesia ◽  
Urinary Retention ◽  
Nerve Block ◽  
Pudendal Nerve ◽  
Deep Sedation ◽  
Randomized Study ◽  
Prospective Randomized Study ◽  
Ultrasound Guided

Background and Objectives. Several anesthesia techniques were applied to hemorrhoidectomy, but postoperative pain and urinary retention were still two unsolved problems. The aim of this prospective randomized study was to evaluate the effect of ultrasound-guided pudendal nerve block (PNB) combined with deep sedation compared to spinal anesthesia for hemorrhoidectomy. Methods. One hundred and twenty patients undergoing Milligan–Morgan hemorrhoidectomy were randomized to receive PNB combined with deep sedation using propofol (Group PNB, n = 60) or spinal anesthesia (Group SA, n = 60). Pain intensity was assessed using the visual analogue scale (0: no pain to 10: worst possible pain). The primary outcome was pain scores recorded at rest at 3, 6, 12, 24, 36, and 48 h and on walking at 12, 24, 36, and 48 h postoperatively. Secondary outcomes were analgesic consumption, side effects, and patient satisfaction after surgery. Results. Ultrasound-guided bilateral PNB combined with deep sedation using propofol could successfully be applied to Milligan–Morgan hemorrhoidectomy. Postoperative pain intensity was significantly lower in Group PNB compared to Group SA at rest at 3, 6, 12, 24, 36, and 48 h ( p < 0.001 ) and during mobilization at 12, 24, 36, and 48 h ( p < 0.001 ) postoperatively. Sufentanil consumption in Group PNB was significantly lower than that in Group SA, during 0–24 h ( p < 0.001 ) and during 24–48 h ( p < 0.001 ) postoperatively. Urinary retention was significantly lower in Group PNB compared to Group SA (6.9% vs 20%, p = 0.034 ). The patients in Group PNB had higher satisfaction compared to Group SA ( p < 0.001 ). Conclusions. Ultrasound-guided PNB combined with propofol sedation is an effective anesthesia technique for Milligan–Morgan hemorrhoidectomy.

scholarly journals How Much Volume of Local Anesthesia and How Long Should You Wait After Injection for an Effective Wrist Median Nerve Block?

Hand ◽  
2017 ◽  
Vol 13 (3) ◽  
pp. 281-284 ◽  
Author(s):  
Lyndsay M. Lovely ◽  
Yasmin Z. Chishti ◽  
Jennifer L. Woodland ◽  
Donald H. Lalonde
Keyword(s):  
Pilot Study ◽  
Median Nerve ◽  
Local Anesthesia ◽  
Nerve Block ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Needle Stick ◽  
Local Methods ◽  
Long Time ◽  
The Ideal

Background: Many surgeons and emergentologists use non–ultrasound-guided wrist nerve blocks. There is little evidence to guide the ideal volume of local anesthesia or how long we should wait after injection before performing pain-free procedures. This pilot study examined time to maximal anesthesia to painful needle stick in 14 volunteer participants receiving bilateral wrist blocks of 6 versus 11 mL of local. Methods: One surgeon performed all 14 bilateral wrist median nerve blocks in participants who remained blinded until after bandages were applied to their wrist. No one could see which wrist received the larger 11-mL volume injection versus the 6-mL block. Blinded sensory assessors then measured perceived maximal numbness time and numbness to needle stick pain in the fingertips of the median nerve distribution. Results: Failure to get a complete median nerve block occurred in seven of fourteen 6-mL wrist blocks versus failure in only one of fourteen 11-mL blocks. Perceived maximal numbness occurred at roughly 40 minutes after injection, but actual numbness to painful needle stick took around 100 minutes. Conclusions: Incomplete median nerve numbness occurred with both 6- and 11-mL non–ultrasound-guided blocks at the wrist. In those with complete blocks, it took a surprisingly long time of 100 minutes for maximal anesthesia to occur to painful needle stick stimuli to the fingertips of the median nerve distribution. Non–ultrasound-guided median nerve blocks at the wrist as described in this article lack reliability and take too long to work.

scholarly journals Clinical analyses of ultrasound-guided nerve block in lower-extremity surgery: A retrospective study

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902198910
Author(s):  
Chan Kang ◽  
Deuk-Soo Hwang ◽  
Jae-Hwang Song ◽  
Gi-Soo Lee ◽  
Jeong-Kil Lee ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Nerve Block ◽  
Onset Time ◽  
Satisfaction Score ◽  
Ultrasound Guided ◽  
Time Duration ◽  
Tourniquet Time ◽  
Femoral Cutaneous Nerve ◽  
The Mean ◽  
Time Required

Purpose: The purpose of this study is to examine the clinical effects and results of lower-extremity surgery under ultrasound-guided nerve block; time required for nerve block, anesthesia onset time, duration of anesthesia, duration of analgesia, tolerable tourniquet time, visual analog scale (VAS) satisfaction score, and anesthetic-related complications. Methods: A total of 3312 cases (2597 patients) from January 2010 to April 2015 were analyzed retrospectively. A senior author performed ultrasound-guided nerve block of the lateral femoral cutaneous nerve (LFCN, 630 cases), femoral nerve (FN, 2503 cases), obturator nerve (ON, 366 cases), sciatic nerve (SN, 3271 cases), or posterior femoral cutaneous nerve (PFCN, 222 cases) depending on the type of surgery. Time required for nerve block, anesthesia onset time, duration of anesthesia, duration of analgesia, tolerable tourniquet time, VAS satisfaction score, and anesthetic-related complications were analyzed. Results: The mean times required were 1.1 min for SN block, 2.5 min for FN/SN block (1762 cases), and 4.8 min for FN/SN/LFCN/ON block. The mean anesthesia onset time was 48 min. The mean durations of anesthesia were 4.5 h for FN dermatome and 5.6 h for SN dermatome. The mean duration of analgesia was 11.5 h. The mean tolerable tourniquet times after were 35, 51, and 84 min after SN block, FN/SN block, and FN/SN/LFCN/ON block, respectively. The mean VAS satisfaction score was 9.3. There were no anesthetic-related complications, such as infection, hematoma, paralysis, or nerve irritation. Conclusion: Selective block of the LFCN, FN, ON, SN, and PFCN based on the locations of lesions and type of surgery showed favorable clinical results with high efficacy. Ultrasound-guided nerve block may be a good option for anesthesia and analgesia in lower-extremity surgery.

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