scholarly journals Double axillary vein variation diagnosed with ultrasound guidance during infraclavicular nerve block intervention

2019 ◽  
Vol 12 (1) ◽  
pp. bcr-2018-227495
Author(s):  
Başak Altıparmak ◽  
Melike Korkmaz Toker ◽  
Ali İhsan Uysal ◽  
Semra Gümüş Demirbilek
Keyword(s):  
Nerve Block ◽  
Ultrasound Guidance ◽  
Peripheral Nerve Block ◽  
Anaesthetic Management ◽  
Detailed Knowledge ◽  
Axillary Vein ◽  
Nerve Blocks ◽  
Different Types ◽  
Axillary Anatomy ◽  
Peripheral Block

The use of ultrasound guidance increases the safety of peripheral block interventions by allowing anaesthesiologists to simultaneously see the position of block needle, the targeted nerves and surrounding vessels. In this report, we represented three patients diagnosed with double axillary vein variation with ultrasound guidance during infraclavicular nerve block intervention. The patients were scheduled for different types of upper limb surgeries. All patients received infraclavicular nerve block for anaesthetic management. A double axillary vein variation was diagnosed with ultrasound during block interventions. Hydro-location technique was used in all cases and the procedures were completed uneventfully. In the current literature, there is limited number of reports concerning double axillary vein variation. Detailed knowledge of the axillary anatomy is important to avoid complications such as intravascular injection during peripheral nerve block interventions. The use of ultrasound guidance and hydro-location technique should be considered for nerve blocks, especially in the axillary area.

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 Anaesthetic Management of a Known Case of Werner Syndrome by Peripheral Nerve Block in the Orthopaedic Surgery of Forearm

2020 ◽  
Vol 48 (3) ◽  
pp. 251-253
Author(s):  
Azim Honarmand ◽  
◽  
Sayed Arash Mirsatari ◽  
Abolghasem Zarezadeh ◽  
Mohammadreza Safavi ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Orthopaedic Surgery ◽  
Peripheral Nerve Block ◽  
Werner Syndrome ◽  
Anaesthetic Management

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.

scholarly journals Application of ultrasound guidance in the oral and maxillofacial nerve block

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12543
Author(s):  
Zhiwei Cao ◽  
Kun Zhang ◽  
Liru Hu ◽  
Jian Pan
Keyword(s):  
Nerve Block ◽  
Anterior Approach ◽  
Ultrasound Guidance ◽  
Anatomical Landmarks ◽  
Nerve Blocks ◽  
Anatomical Structures ◽  
Maxillary Nerve ◽  
Current Article ◽  
Nerve Localization ◽  
Oral And Maxillofacial Regions

Introduction Nerve block technology is widely used in clinical practice for pain management. Conventional nerve localization methods, which only rely on palpation to identify anatomical landmarks, require experienced surgeons and can be risky. Visualization technologies like ultrasound guidance can help prevent complications by helping surgeons locate anatomical structures in the surgical area and by guiding the operation using different kinds of images. There are several important and complex anatomical structures in the oral and maxillofacial regions. The current article reviews the application of ultrasound guidance in oral and maxillofacial nerve blocks. Methods We searched the literature on the use of ultrasound guidance for the main nerve block techniques in the oral and maxillofacial regions using both PubMed and MEDLINE and summarized the findings. Results and Discussion A review of the literature showed that ultrasound guidance improves the safety and effectiveness of several kinds of puncture procedures, including nerve blocks. There are two approaches to blocking the mandibular nerve: intraoral and extraoral. This review found that the role of ultrasound guidance is more important in the extraoral approach. There are also two approaches to the blocking of the maxillary nerve and the trigeminal ganglion under ultrasound guidance: the superazygomatic approach and the infrazygomatic approach. The infrazygomatic approach can be further divided into the anterior approach and the posterior approach. It is generally believed that the anterior approach is safer and more effective. This review found that the effectiveness and safety of most oral and maxillofacial nerve block operations can be improved through the use of ultrasound guidance.

scholarly journals Ultrasound-guided deep nerve block may increase the rate of local anesthetics toxicity in HBV carriers: A Randomized clinical trial

2019 ◽  
Author(s):  
Xu-hao Zhang ◽  
Yu-jie Li ◽  
Wenquan He ◽  
Chunyong Yang ◽  
Jianteng Gu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Trial ◽  
Nerve Block ◽  
Nerve Stimulation ◽  
Local Anesthetics ◽  
Ultrasound Guidance ◽  
Female Gender ◽  
Hbv Infection ◽  
Nerve Stimulator ◽  
Nerve Blocks

Abstract Background: Ultrasound-guidance might decrease the incidence of local anesthetics systemic toxicity(LAST) for many peripheral nerve blocks compared to nerve stimulation. However, it remained uncertain whether ultrasound-guidance would be superior to the nerve stimulation for deep nerve block in the lower extremity. This study was designed to investigate that deep nerve block with ultrasound-guidance would result in a lower rate of LAST comparing to that with nerve stimulator-guidance. Methods: Three hundred patients who were for elective lower limb surgery and desiring lumbar plexus blocks(LPBs) and sciatic nerve blocks(SNBs) were enrolled in this study. Patients were randomly assigned to receive LPB and SNB with ultrasound-guidance (Group U), nerve stimulator-guidance (Group N) and dual-guidance (Group M). The primary outcome was the incidence of the LAST. The secondary outcomes were number of needle redirections, motor and sensory block onset and restoration times in the nerve distributions, and associated risk factors. Results: There were 18 patients with the LAST, including 12 in group U, 4 in group N and 2 in group M. For multiple comparisons among the tree groups, we found that the incidence of LAST in group U(12%) was significantly higher than that in group N(4%)(P=0.037) and group M(2%)(P=0.006). The OR of LAST with HBV infection and female gender was 3.352(95% CI,1.233-9.108, P=0.013 ) and 9.488(95% CI,2.142-42.093, P=0.0004), respectively. Conclusions: For patients undergoing LPBs and SNBs, use of ultrasound may increase the incidence of the LAST. HBV infection and female gender were risk factors for deep nerve block. Trial registration: This study was approved by the human research review committee at the southwest hospital of third military medical university. The protocol was registered prospectively with Chinese Clinical Trial Registry (ChiCTR-IOR-16008099) on March 15th，2016. Keywords: Ultrasound; nerve stimulation; nerve block; female; HBV; LAST

scholarly journals The selection of best anesthesiological technique for hip fracture surgery in older high-risk patients

2012 ◽  
Vol 59 (3) ◽  
pp. 113-115 ◽  
Author(s):  
Nevenka Radic ◽  
Kristina Radinovic ◽  
Mihailo Ille ◽  
Aleksandar Lesic ◽  
Mirjana Ljubicic-Stojanovic ◽  
...  
Keyword(s):  
Hip Fracture ◽  
High Risk ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Pathological Condition ◽  
Older Age ◽  
Spontaneous Respiration ◽  
Nerve Blocks ◽  
Selection Of

Introduction: Hip fracture is a pathological condition, more common in older age, i.e. in people over 65 years. The prevalence of this disorder is continuously increasing, simultaneously with higher age limit. In evaluation of risk for operation and anesthesia, older age itself represents higher risk and calls for special attention. In selection of anesthesiological technique, it is more usual to apply neuroaxial block or peripheral nerve block, which is more advantageous over general anesthesia. CASE REPORT: A female, 80-year old, patient B.D. was admitted to hospital for hip fracture, with the diagnosis of the right, lateral, basicervical femoral fracture. On admission, heart decompensation (decompensated dilated myocardiopathy), pulmonary edema and the left lateral pleural effusion were established. Due to high risk (ASA III) of intraoperative and postoperative complications, it was decided to apply combined peripheral nerve block. Using the neurostimulators, 3-in-1 block, lumbosacral block and sciatic nerve block were applied. During the operation, the patient was sedated by Propofol and had spontaneous respiration through the laryngeal mask. Intra- and postoperatively, the patient?s hemodynamics was stable. Conclusion: Peripheral nerve blocks are safe and effective anesthesiological technique, which may reduce the mortality in patients with the hip fracture and maintain the hemodynamic stability, both during and after the surgical intervention.

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