scholarly journals Safe preoperative regional nerve blocks

2022 ◽  
Vol 11 (1) ◽  
pp. e001370
Author(s):  
Joseph Christopher Arbizo ◽  
Kajal Dalal ◽  
Veronia Lao ◽  
Frank Rosinia ◽  
Temiloluwa Adejuyigbe
Keyword(s):  
Nerve Block ◽  
Proper Time ◽  
Effective Means ◽  
Nerve Blocks ◽  
Safety Communication ◽  
Direct Observations ◽  
Time Out ◽  
Regional Nerve Block ◽  
Procedural Time ◽  
Multidisciplinary Model

BackgroundProcedural time-outs and checklists are proven to be an effective means of improving teamwork and preventing wrong-sided procedures. The main objective of this study was to ensure that all regional nerve blocks being performed in the preoperative area at our hospital were executed with a proper time-out. The goal of this project was to increase integration of a safe preoperative block process including a time-out checklist to ensure; complete consents, correct patient and laterality were marked prior to each procedure. We focused on recognising events that took place before, during and after the nerve block including non-compliance with the checklist and deviations from protocol.MethodsA safe preoperative block process current and future state flowchart, revised time-out checklist and action/implementation plan as part of our Plan–Do–Study–Act model was constructed using a multidisciplinary approach. Pre-implementation and post- implementation data were collected by medical students acting anonymously via direct observation noting the presence of an anaesthesiologist, resident, nurse, time-out for procedure, checklist completed and procedure start and sedation time representing a complete time-out.ResultsThe direct observations in the pre-implementation group showed a 20% (3/15) compliance with a correct time-out. The direct observations in the post implementation group showed 85% (12/14) compliance. This revealed a 65% increase in all portions of the time-out checklist completed. Comparative analysis confirmed decrease in non-compliance and deviations from protocol as displayed by 65% increase in all portions of time-out checklist completed.ConclusionWe aimed to improve safety, communication and compliance for preoperative nerve blocks through development and implementation of a safe preoperative block process using a multidisciplinary model. We conclude that creation of a safe nerve block was achieved by integration of a preoperative nerve block process which included increased compliance to the time-out checklist, verifying patients and laterality with marking of patient prior to each procedure, identifying proper consents were completed and ensuring each regional nerve block was executed with a proper time-out.

Effects of anesthesia versus regional nerve block on major leg amputation mortality rate

Vascular ◽  
2013 ◽  
Vol 21 (2) ◽  
pp. 83-86 ◽  
Author(s):  
Roy Lin ◽  
Anil Hingorani ◽  
Natalie Marks ◽  
Enrico Ascher ◽  
Robert Jimenez ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Nerve Block ◽  
Medical Center ◽  
Supporting Evidence ◽  
Nerve Blocks ◽  
Regional Nerve Block ◽  
Social Security Death Index ◽  
Mortality Outcome ◽  
The Usa ◽  
Leg Amputation

There are greater than 120,000 above-knee amputations (AKA) and below-knee amputations (BKA) performed in the USA each year. Traditionally, general anesthesia (GA) was the preferred modality of anesthesia. The use of regional nerve blocks has recently gained popularity, however, without the supporting evidence of any mortality benefits. Our objective was to evaluate whether regional nerve blocks yield significant mortality reduction in major lower-extremity amputations. Retrospective data of both AKA and BKA procedures at the Maimonides Medical Center from 2005 to 2009 were analyzed. Patients received either general sedation, spinal or ultrasound-guided regional nerve blocks as per decision of the attending anesthesiologist. Regional nerve blocks for major lower-extremity amputations consisted of femoral, sciatic, saphenous and popliteal nerve blocks. A retrospective inquiry of 30-day mortality was performed with reference to the Social Security Death Index and hospital records. One hundred and fifty-eight patients were included in the study (82 men and 86 women with mean age of 74.5 years ± 12.9 SD, range of 33-98 years) of which 46 patients had regional nerve blocks and 112 had GA or spinal blocks. Patients who received both regional blocks and GA/spinal blocks within 30 days were excluded. The overall 30-day mortality was 17.1% (27 patients) consisting of 15.2% for regional nerve analgesia versus 17.9% for GA/spinal blocks ( P = 0.867). Age did not affect mortality outcome in either groups of anesthesia modality. Our analysis did not reveal any mortality benefit of utilizing regional nerve block over GA or spinal blocks.

Thermographic evaluation of the autonomic effects of nerve blocks in the foot

1989 ◽  
Vol 79 (3) ◽  
pp. 107-115
Author(s):  
AM Jacobs ◽  
R Esper ◽  
R O'Leary ◽  
ZM Duda ◽  
W Yorzyk
Keyword(s):  
Blood Flow ◽  
Nerve Block ◽  
Tibial Nerve ◽  
Posterior Tibial Nerve ◽  
Nerve Blocks ◽  
Posterior Tibial ◽  
Bupivacaine Hydrochloride ◽  
Regional Nerve Block ◽  
Skin Temperatures ◽  
Increased Blood Flow

The authors evaluated regional skin temperatures of the foot following the administration of a variety of local anesthetic nerve blocks with either Xylocaine (lidocaine hydrochloride) or Sensorcaine (bupivacaine hydrochloride). The study was carried out on ten randomized parallel groups of five subjects, each group being tested with one drug and one regional nerve block. The results indicated that both Xylocaine and Sensorcaine, when administered as a posterior tibial block, result in a significantly increased blood flow to the foot. Nerve blockade of the remaining nerves of the foot did not significantly increase the sympatholytic effect obtained by posterior tibial nerve block alone.

Buffering mepivacaine with sodium bicarbonate speeds and potentiates analgesia of median and ulnar nerve blocks performed on horses

2019 ◽  
Vol 184 (5) ◽  
pp. 155-155 ◽  
Author(s):  
Lindsey Boone ◽  
John Schumacher ◽  
Fred DeGraves ◽  
Robert Cole
Keyword(s):  
Sodium Bicarbonate ◽  
Ulnar Nerve ◽  
Nerve Block ◽  
Inertial Sensor ◽  
Motion Analysis System ◽  
Separate Study ◽  
Nerve Blocks ◽  
Regional Nerve Block ◽  
Analysis System ◽  
Time To Onset

The objective of this study was to determine if buffering mepivacaine HCL (mepHCl) with sodium bicarbonate (NaHCO3) would significantly decrease the time to onset of analgesia when performing median and ulnar nerve blocks in naturally lame horses. Median and ulnar nerve blocks were performed on the naturally lame limb of nine horses during two separate study periods, with a minimum washout period of three days between study periods. Nerve blocks were performed by administering mepHCl alone or mepHCl mixed with NaHCO3 (nine parts 2 per cent mepHCl to one part 8.4 per cent NaHCO3). Lameness was evaluated objectively using a wireless, inertial, sensor-based, motion analysis system (Lameness Locator) prior to the high regional nerve block and every five minutes following administration of the nerve block for 75 min. Resolution of lameness occurred earlier and was more profound for horses administered median and ulnar nerve blocks performed with mepHCl and NaHCO3 than when these nerve blocks were performed using only mepHCl.

scholarly journals Prolonged Use of a Continuous Peripheral Nerve Block Catheter for Analgesia after Pediatric Foot and Ankle Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Jake MacDonald ◽  
De-An Zhang
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Effective Means ◽  
Metatarsal Osteotomy ◽  
Opioid Use ◽  
Nerve Blocks ◽  
First Metatarsal ◽  
Pediatric Foot ◽  
One Year

Continuous peripheral nerve blocks (CPNB) have a variety of indications and have been shown to be a safe and effective means of minimizing pain postoperatively. Early studies have indicated duration of catheter use greater than 48 hours as a main contributor to infection risk in CPNBs. Recent studies, though, have suggested that the risk of infection does not increase until 4 days after insertion. In the following case report, we recount our experience in using a continuous popliteal-sciatic peripheral nerve block for postoperative pain control in a pediatric patient following calcaneal and first metatarsal osteotomy. The catheter remained in place for 65 hours postoperatively without signs of local inflammation or infection. The prolonged CPNB use resulted in a significant decrease in postoperative opioid use and pain and increase in patient satisfaction when compared to the same procedure done one year prior on the opposite foot.

Postoperative Pain Management

2018 ◽  
Author(s):  
Abhishek Parmar
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Clinical Information ◽  
Postoperative Pain Management ◽  
Patient Controlled Analgesia ◽  
Management Options ◽  
Nerve Blocks ◽  
Epidural Catheter Placement ◽  
Opiate Abuse ◽  
Regional Nerve Block

The aim of this review is to provide practical clinical information on modern pain management options to guide the clinician on evidence-based practices, optimizing the treatment of pain and avoiding practices that may lead to potential abuse. Postoperative pain management is an essential component of any surgeon’s practice and has clear implications for surgical outcomes, patient satisfaction, and population health. Understanding options within a multimodal approach to pain management in the acute setting is a key determinant to improving outcomes for our patients. This review discusses multimodal analgesic options, including a variety of pain medications (opiates, antiinflammatory medications, and patient-controlled analgesia) and techniques (epidural catheter placement, regional nerve blocks) to be used in tandem. Lastly, best possible practices to avoid opiate abuse are discussed. This review contains 4 figures, 5 tables, 1 video and 96 references. Key words: antiinflammatories, epidural, narcotics, patient-controlled analgesia, postoperative pain, regional nerve block

Automated text messaging follow-up for patients who receive peripheral nerve blocks

2021 ◽  
pp. rapm-2021-102472
Author(s):  
Daniel Gessner ◽  
Oluwatobi O Hunter ◽  
Alex Kou ◽  
Edward R Mariano
Keyword(s):  
Regional Anesthesia ◽  
Nerve Block ◽  
Text Messaging ◽  
Low Cost ◽  
Automated System ◽  
Phone Call ◽  
Nerve Blocks ◽  
Patient Response ◽  
Patient Reported

BackgroundRoutine follow-up of patients who receive a nerve block for ambulatory surgery typically consists of a phone call from a regional anesthesia clinician. This process can be burdensome for both patients and clinicians but is necessary to assess the efficacy and complication rate of nerve blocks.MethodsWe present our experience developing an automated system for completing follow-up via short message service text messaging and our preliminary results using it at three clinical sites. The system is built on REDCap, a secure online research data capture platform developed by Vanderbilt University and currently available worldwide.ResultsOur automated system queried patients who received a variety of nerve block techniques, assessed patient-reported nerve block duration, and surveyed patients for potential complications. Patient response rate to text messaging averaged 91% (higher than our rates of daily phone contact reported previously) for patients aged 18 to 90 years.ConclusionsGiven the wide availability of REDCap, we believe this automated text messaging system can be implemented in a variety of health systems at low cost with minimal technical expertise and will improve both the consistency of patient follow-up and the service efficiency of regional anesthesia practices.

Shingles Following Axillary Nerve Block a Case Report

1986 ◽  
Vol 11 (1) ◽  
pp. 115-116
Author(s):  
N. J. PERCIVAL
Keyword(s):  
Case Report ◽  
Herpes Zoster ◽  
Nerve Block ◽  
Upper Limb ◽  
Axillary Nerve ◽  
Nerve Blocks ◽  
Upper Limb Surgery ◽  
Axillary Nerve Block

Axillary nerve blocks are now frequently used for emergency and elective upper limb surgery. The method gives reliable anaesthesia with few complications. A case is described in which a patient developed Herpes Zoster following an Axillary Nerve Block, a hitherto unreported complication.

scholarly journals How Effective Is a Regional Nerve Block for Treating Pain Associated With Hip Fractures?

2018 ◽  
Vol 71 (3) ◽  
pp. 378-380 ◽  
Author(s):  
Michael Gottlieb ◽  
Nicholas Chien ◽  
Thomas Seagraves
Keyword(s):  
Nerve Block ◽  
Hip Fractures ◽  
Regional Nerve Block

Does a digital regional nerve block improve the accuracy of noninvasive hemoglobin monitoring?

2012 ◽  
Vol 26 (6) ◽  
pp. 845-850 ◽  
Author(s):  
Ronald D. Miller ◽  
Theresa A. Ward ◽  
Charles E. McCulloch ◽  
Neal H. Cohen
Keyword(s):  
Nerve Block ◽  
Regional Nerve Block

scholarly journals Upper Airway Nerve Block for Rigid Bronchoscopy in the Patients with Tracheal Stenosis: A Case Serie

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Parviz Amri ◽  
Novin Nikbakhsh ◽  
Seyed Reza Modaress ◽  
Ramin Nosrati
Keyword(s):  
Respiratory Distress ◽  
Nerve Block ◽  
Tracheal Stenosis ◽  
Superior Laryngeal Nerve ◽  
Upper Airway ◽  
Rigid Bronchoscopy ◽  
Laryngeal Nerve ◽  
Intravenous Sedation ◽  
Nerve Blocks

Background: Rigid bronchoscopy is often used to diagnose and treat the location of resection of the tracheal stenosis. It is a selective procedure for the dilatation of tracheal stenosis, especially when accompanied by respiratory distress. Objectives: We introduced patients who were diagnosed with tracheal stenosis and candidate for rigid bronchoscopy dilatation by the upper airway nerve blocks. Methods: This prospective observational study was conducted on 17 patients who underwent dilatation with rigid bronchoscopy in tracheal stenosis at Hospitals affiliated with Babol University of Medical Sciences from 2002 to 2017. The patients were given three nerve blocks, 6 bilateral superior laryngeal nerve block, bilateral glossopharyngeal nerve block, and recurrent laryngeal nerve block (transtracheal) before awake rigid bronchoscopy using 2% lidocaine. We evaluated the demographic data, the cause of tracheal stenosis, the quality of the airway nerve block (Intubation score), patients’ satisfaction from bronchoscopy and thoracic surgeons’ satisfaction. Complications of nerve blocks were recorded. Results: From 2002 to 2017, 17 patients (14 were male and 3 were) female with tracheal stenosis who were candidates for dilatation with bronchoscopy and accepted the upper nerve block were included. The quality of the block was acceptable in 16 (94%) patients. 15 patients received fentanyl, and only two patients did not need to intravenous sedation. The mean age of patients was 29.59 ± 11.59. The average satisfaction of the surgeon was 8.82 ± 1.13 and the satisfaction of patients with anesthesia was 8.89 ± 1.16. There was one serious complication (laryngospasm) in one patient. Conclusions: The upper airway nerve block method is a suitable anesthesia technique for patients with tracheal stenosis who are candidates for the tracheal dilatation with rigid bronoscopy, especially when the patient has respiratory distress and has not been evaluated before surgery.

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