Remifentanil for analgesia during retrobulbar nerve block placement

Background Obturator nerve block is highly recommended for knee surgery in addition to a femoral nerve block. The main disadvantage of the classic approach at the pubic tubercle is low patient acceptance due to pain and discomfort. The authors hypothesized that the use of a new inguinal obturator nerve block technique would reduce pain and discomfort in patients. Methods The inguinal approach was simulated in five fresh cadavers. Injection of latex was performed in two cadavers. The location of the needle and the extent of latex solution were analyzed. Fifty patients scheduled to undergo arthroscopic knee surgery were randomly assigned to receive obturator nerve block using either the inguinal (n = 25) or the pubic tubercle approach (n = 25). Results In all cadavers, the needle was close to the obturator nerve branches, which were surrounded by the latex solution. In the clinical study, visual analog scale pain scores and discomfort of block placement were significantly lower in the inguinal group compared with the pubic tubercle group (P < 0.01). In the inguinal group, there was a significant decrease in block performance time (P < 0.05) and in bolus of propofol and fentanyl used for the procedure (P < 0.01). Twenty minutes after application of the block, adductor strength decrease, occurrence, and location of cutaneous distribution of the obturator nerve were not significantly different between the groups. The incidence of minor complications was significantly increased in the pubic tubercle group (P < 0.05). No major complications were observed. Conclusions The new inguinal approach decreases patient discomfort and pain of block placement as well as the time and sedation and analgesics required for a similar quality of sensory and motor block compared with the pubic tubercle approach.

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Remifentanil for analgesia during retrobulbar nerve block placement

European Journal of Anaesthesiology ◽

10.1017/s0265021505000098 ◽

2005 ◽

Vol 22 (1) ◽

pp. 40-43 ◽

Cited By ~ 2

Author(s):

W. Leidinger ◽

P. Schwinn ◽

H.-M. Hofmann ◽

J. N. Meierhofer

Keyword(s):

Nerve Block ◽

Block Placement

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Popliteal Sciatic Nerve Block for Postoperative Analgesia

Foot & Ankle International ◽

10.1177/107110079601700704 ◽

1996 ◽

Vol 17 (7) ◽

pp. 378-382 ◽

Cited By ~ 68

Author(s):

Kurt Rongstad ◽

Roger A. Mann ◽

David Prieskom ◽

Steve Nichelson ◽

Greg Horton

Keyword(s):

Sciatic Nerve ◽

Nerve Block ◽

Sciatic Nerve Block ◽

Needle Placement ◽

Nerve Stimulator ◽

Peripheral Nerve Stimulator ◽

Control Regimen ◽

Ankle Surgery ◽

Block Placement ◽

Better Than

Eighty-six patients were evaluated prospectively following the placement of a sciatic nerve block in the popliteal fossa after a major foot or ankle operation. Needle placement was guided by a peripheral nerve stimulator and 30 ml of 0.5% bupivacaine with epinephrine was used. Ninety-seven percent of patients had a successful block. Only one patient had severe discomfort during the block placement. The block lasted an average of 20 hours. During the first 24 hours after surgery, patients took an average of three hydrocodone tablets. Twenty-two of the 23 patients who had had previous major foot or ankle surgery found that the block was better than their previous pain control regimen. No patient had complications related to the block and 95% were satisfied and would have the block again.

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Influence of Sensory and Proprioceptive Impairment on the Development of Phantom Limb Syndrome during Regional Anesthesia

Anesthesiology ◽

10.1097/00000542-200404000-00032 ◽

2004 ◽

Vol 100 (4) ◽

pp. 979-986 ◽

Cited By ~ 13

Author(s):

Xavier Paqueron ◽

Morgan Leguen ◽

Marc E. Gentili ◽

Bruno Riou ◽

Pierre Coriat ◽

...

Keyword(s):

Brachial Plexus ◽

Regional Anesthesia ◽

Nerve Block ◽

Elbow Flexion ◽

Initial Position ◽

Phantom Limb ◽

Group A ◽

Sensorimotor Impairment ◽

Block Placement ◽

Group B

Background The relation between impairment of sensorimotor function and occurrence of phantom limb syndrome (PLS) during regional anesthesia has not been described. This study assessed the temporal relation between PLS and the progression of sensorimotor impairment during placement of a brachial plexus nerve block. Methods Fifty-two patients had their arm randomly placed either alongside their body (group A) or in 90 degrees abduction (group B) immediately after brachial plexus nerve block placement. Responses to pin prick, cold, heat, touch, proprioception, and voluntary movement were assessed every 5 min for 60 min. Meanwhile, patients described their perceptions of the size, shape, and position of their anesthetized limb. Results Phantom limb syndrome occurred 19 +/- 9 min after nerve block placement. Proprioception was impaired and abolished after 22 +/- 9 and 43 +/- 17 min, respectively (P < 0.05 vs. PLS onset). When PLS occurred, responses to pin prick, cold, heat, and proprioception were abolished in 96, 94, 87, and 4% of patients, respectively. Patients were more likely to feel their anesthetized limb in adduction and in abduction in groups A and B (P < 0.05 vs. group A), respectively. After PLS had become motionless, two stereotyped positions were identified: arm adduction, elbow flexion, hand over the abdomen (68% of group A patients) and arm abduction, elbow flexion, hand held close to the homolateral ear (48% of group B patients). Conclusions This study provides a better understanding of the determinants of PLS by showing that the final position of PLS is related both to the abolition of proprioception and the initial position of the anesthetized limb.

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Nerve Stimulator and Multiple Injection Technique for Upper and Lower Limb Blockade

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0044 ◽

2018 ◽

pp. 235-240

Keyword(s):

Peripheral Nerve ◽

Nerve Block ◽

Peripheral Nerve Block ◽

Patient Acceptance ◽

Injection Technique ◽

Neurologic Complications ◽

Multiple Injection ◽

Nerve Stimulator ◽

Nerve Blocks ◽

Block Placement

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.

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