scholarly journals An Estimation of the Minimum Effective Anesthetic Volume of 2% Lidocaine in Ultrasound-guided Axillary Brachial Plexus Block

2009 ◽  
Vol 111 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Brian D. O’Donnell ◽  
Gabrielle Iohom
Keyword(s):  
Brachial Plexus ◽  
Local Anesthetic ◽  
Brachial Plexus Block ◽  
Hand Surgery ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Performance Time ◽  
Axillary Brachial Plexus Block ◽  
Block Success ◽  
Plexus Block

Background Ultrasound guidance facilitates precise needle and injectate placement, increasing axillary block success rates, reducing onset times, and permitting local anesthetic dose reduction. The minimum effective volume of local anesthetic in ultrasound-guided axillary brachial plexus block is unknown. The authors performed a study to estimate the minimum effective anesthetic volume of 2% lidocaine with 1:200,000 epinephrine (2% LidoEpi) in ultrasound-guided axillary brachial plexus block. Methods After ethical approval and informed consent, patients undergoing hand surgery of less than 90 min duration were recruited. A step-up/step-down study model was used with nonprobability sequential dosing based on the outcome of the previous patient. The starting dose of 2% LidoEpi was 4 ml per nerve. Block failure resulted in a dose increase of 0.5 ml; block success in a reduction of 0.5 ml.A blinded assistant assessed sensory and motor blockade at 5-min intervals up to 30 min. Block performance time and duration were measured. Two predetermined stopping points were used; a minimum of five consecutive block success/failures and five consecutive successful blocks at 1 ml per nerve. Results The study was terminated when five consecutive patients had successful blocks using 1 ml of 2% LidoEpi per nerve (overall group n = 11). All five patients had surgical anesthesia within 10 min. The mean (SD) block performance time was 445 (100) s, and block duration was 190 min (range 120-310 min). All surgical procedures were performed under regional anesthesia with anxiolytic sedation provided in 3 of 11 cases. Conclusion Successful ultrasound-guided axillary brachial plexus block may be performed with 1 ml per nerve of 2% LidoEpi.

scholarly journals Effects of local anaesthetic dilution on the characteristics of ultrasound guided axillary brachial plexus block: a randomised controlled study

2021 ◽  
Author(s):  
Anil Ranganath ◽  
Osman Ahmed ◽  
Gabriella Iohom
Keyword(s):  
Brachial Plexus ◽  
Local Anaesthetic ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Ultrasound Guided ◽  
Performance Time ◽  
Axillary Brachial Plexus Block ◽  
Group 2 ◽  
Plexus Block ◽  
Group 1

Aims: Ultrasound guidance has led to marked improvement in the success rate and characteristics of peripheral nerve blocks. However, effects of varying the volume or concentration of a fixed local anaesthetic dose on nerve block remains unclear. The purpose of our study was to evaluate whether at a fixed dose of lidocaine, altering the volume and concentration will have any effect on the onset time of ultrasound-guided axillary brachial plexus block.Material and methods: Twenty patients were randomised to receive an ultrasound-guided axillary brachial plexus block with either lidocaine 2% with epinephrine (20 ml, Group 2%) or lidocaine 1% with epinephrine (40 ml, Group 1%). The primary endpoint was block onset time. Secondary outcomes included duration of the block, performance time, number of needle passes, incidence of paraesthesia and vascular puncture.Results: The median [IQR] onset time of surgical anaesthesia was shorter in Group 1% when compared to Group 2% (6.25 [5-7.5] min vs 8.75 [7.5-10] min; p=0.03). The mean (SD) overall duration of surgical anaesthesia was significantly shorter in Group 1% compared to Group 2% (150.9±17.2 min vs 165.1±5.9 min; p=0.02). Group 1% had a shorter performance time with fewer needle passes. The incidence of vascular puncture and paraesthesia was similar in the two groups.Conclusion: Ultrasound-guided axillary brachial plexus blocks performed using a higher volume of lower concentration lidocaine was associated with shorter onset time and duration of surgical anaesthesia.

scholarly journals Efficacy and safety of ultrasound-guided brachial plexus blocks for upper limb surgery

2015 ◽  
Vol 10 (2) ◽  
pp. 164-171
Author(s):  
Raluca UNGUREANU ◽  
◽  
Liliana MIREA ◽  
Ioana GRINŢESCU ◽  
Dan TULBURE ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Local Anesthetic ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Ultrasound Guided ◽  
Block Success ◽  
Upper Limb Surgery ◽  
Locoregional Anesthesia ◽  
Plexus Block

Introduction. The use of ultrasound (US) for brachial plexus block has increased enthusiasm because the anesthesiologist can visualize anatomy, needle placement, and local anesthetic spread during locoregional anesthesia. The objectives of this prospective study was to evaluate the efficacy and the safety of ultrasound guided brachial plexus block comparative with traditional method of neurostimulation. Material and methods. In this randomized controlled clinical trial we included patients over 18 years old with upper limb surgery and who benefit of brachial plexus block (axillary, interscalenic or combined blocks). After monitoring and sedation, the patients randomly received ultrasound-guided (62 pts.) or neuro stimulation (63 pts.) brachial plexus block with ropivacaine 0.5%. We recorded data about: block success rate, sensitive and motor block onset time, block performance time, immediate and late complications events, patient’s satisfaction rate. The results were statistically analyzed, with significance assumed at p<0.05. Results. Block success rate with ultrasound guidance was very high (93.5% in US group and 84% in NS group). The patients of US group received less volume of local anesthetic (20.89 ± 3.9 ml vs. 43 ± 5.1 ml in NS group, p < 0.05). The performance time, needle punctures, sensory and motor onset time was significant reduced in US group. In the NS group we recorded 2 local anesthetic systemic toxicity (minor-moderate neurologic symptoms) with complete recovery and none in US group. We recorded less paresthesia during block performance and vascular puncture due to US guidance (p<0.05). Patient acceptance with locoregional anesthesia is good, even patients experience more discomfort during neurostimulation technique. Conclusions. The results of this study suggest that both techniques of execution of brachial plexus block are adequate for upper limb surgery but US guidance provides significant benefits for patients in terms of efficacy and safety.

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 Comparative Anesthesia Effect of Brachial Plexus Block Based on Smart Electronic Medical Ultrasound-Guided Positioning and Traditional Anatomical Positioning

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Zhaoxiang Yu ◽  
Yang Liu ◽  
Chunlei Zhu
Keyword(s):  
Arterial Pressure ◽  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Hand Surgery ◽  
Anatomical Variations ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Visualization Technology ◽  
Plexus Block ◽  
Time Point

With the intensification of population aging, the improvement of visualization technology, and the concept of accelerated rehabilitation surgery, the anesthesia method of upper extremity surgery is gradually changing. However, these methods are often caused by anatomical variations and often have low block success rates and patient satisfaction. The neuroanatomical position should be accurately located so that the puncture needle is right next to the nerve bundle or in the nerve sheath. This is very important for implementing accurate brachial plexus anesthesia. This article uses ultrasound-guided positioning technology and traditional anatomical positioning technology for brachial plexus block treatment, aiming to explore the anesthesia effect of brachial plexus block with different techniques. This article selects 120 patients undergoing brachial plexus block surgery for forearm or hand surgery and divides these 120 patients into 6 groups with 20 people in each group. The first 3 groups were treated with brachial plexus block using ultrasound-guided positioning technology. The latter 3 groups were treated with brachial plexus block using traditional anatomical positioning technology. Experiments proved that during anesthesia, compared with the ultrasound group, the heart rate of the traditional anatomy group was significantly decreased ( P < 0.05 ), and the average arterial pressure of the six groups of patients at each time point had no statistical difference ( P > 0.05 ). This shows that whether it is ultrasound-guided positioning technology or traditional anatomical positioning technology, it has no effect on the average arterial pressure of the patient at each time point. In addition to intuitive and accurate viewing of needle and nerve contact, ultrasound real-time guidance allows intuitive viewing of anesthesia. This is a special advantage of nerve block under ultrasound guidance.

scholarly journals Comparison between Single- and Double-Injection Technique for Ultrasound-Guided Supraclavicular Block: A Randomized Controlled Study

2021 ◽  
pp. 1-6
Author(s):  
Suresh Kumar Vallapureddy ◽  
Gajanan Fultambkar ◽  
V. Rajeswar Rao ◽  
Vinay Kukreja ◽  
Rammohan Gurram ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Local Anesthetic ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Demographic Data ◽  
Controlled Study ◽  
Injection Technique ◽  
Double Injection ◽  
Performance Time ◽  
Plexus Block

<b><i>Background:</i></b> The supraclavicular approach to brachial plexus block is a commonly employed regional anesthesia technique for providing surgical anesthesia and postoperative analgesia for patients undergoing upper limb fractures. With ultrasound (US) guidance, the success rate of the block is increased, and complications like pneumothorax and vascular puncture are minimized. The block can be performed using single injection at the corner pocket or double injection, that is, half of the drug at the corner pocket and the remaining half at the cluster of brachial plexus divisions. <b><i>Methods:</i></b> After institutional ethics committee approval, we randomized 40 patients scheduled with fractures for elective upper extremity surgery under US-guided supraclavicular brachial plexus block. Twenty patients received 30 mL of local anesthetic at the corner pocket (group SI), and 20 patients received 30 mL of local anesthetic using the dual-injection technique in divided doses (group DI). Demographic data, time to block performance, time to sensory and motor block, total anesthesia-related time (TART), block success, and failure were compared between both groups. <b><i>Results:</i></b> The demographic data were comparable between both groups. The DI group had a significantly faster onset than the SI group (<i>p</i> = 0.0172). There was a statistically significant lesser performance time in group SI than in group DI (<i>p</i> &#x3c; 0.034). The sensory and motor block achieved was comparable between both groups. <b><i>Conclusion:</i></b> The success rates in both the SI and DI techniques are comparable. The DI technique results in a faster onset and hence a shorter TART; however, it may not be clinically relevant.

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