Comparing outcomes after peripheral nerve block versus general anesthesia for lower extremity amputation: a nationwide exploratory retrospective cohort study in Japan

2020 ◽  
Vol 45 (6) ◽  
pp. 399-404 ◽  
Author(s):  
Hiroaki Abe ◽  
Masahiko Sumitani ◽  
Hiroki Matsui ◽  
Shotaro Aso ◽  
Reo Inoue ◽  
...  
Keyword(s):  
Propensity Score ◽  
Lower Extremity ◽  
Peripheral Nerve ◽  
General Anesthesia ◽  
Nerve Block ◽  
Postoperative Delirium ◽  
Peripheral Nerve Block ◽  
Lower Extremity Amputation ◽  
Significant Difference ◽  
Extremity Amputation

Background and objectivesThe health benefits of peripheral nerve block (PNB) on postoperative complications after lower extremity amputation (LEA) compared with general anesthesia (GA) remains controversial. We performed a retrospective propensity score-matched cohort analysis to compare major outcomes after LEA with PNB versus GA.Materials and methodsWe used a nationwide inpatient database in Japan to compare patient outcomes after LEA with PNB versus GA from 2010 to 2016. Our primary outcome was 30-day mortality after LEA. The incidence of composite morbidity from life-threatening complications and of delirium within 30 days after LEA were secondary outcomes. We conducted propensity score-matched analyses of patients who underwent below knee or foot amputation using 36 covariates. Logistic regression analyses fitted with generalized estimating equations were performed to calculate ORs and their 95% CIs.ResultsOf 11 796 patients, 747 received PNB and 11 049 received GA. After one-to-four propensity score matching, 747 patients were included in the PNB group and 2988 in the GA group. The adjusted ORs for postoperative mortality, composite morbidity and delirium within 30 days after LEA were 1.11 (95% CI 0.75 to 1.64), 1.15 (95% CI 0.85 t o1.56) and 0.75 (95% CI 0.57 to 0.98), respectively, for the PNB group with reference to the GA group.ConclusionsThere was no significant difference between groups in 30-day mortality or composite morbidity. The PNB group showed a significantly lower risk of postoperative delirium than the GA group. Our findings suggest that PNB may have advantages over GA in preventing postoperative delirium among patients undergoing LEA.

scholarly journals Functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery: a systematic review protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Jennifer Héroux ◽  
Emilie Belley-Côté ◽  
Pablo Echavé ◽  
Marie-Josée Loignon ◽  
Pierre-Olivier Bessette ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peripheral Nerve ◽  
General Anesthesia ◽  
Nerve Block ◽  
Upper Limb ◽  
Functional Recovery ◽  
Peripheral Nerve Block ◽  
Upper Limb Surgery ◽  
Grade Methodology ◽  
The Impact

Abstract Background Peripheral nerve block is a single injection that inhibits the transmission of peripheral nerve impulses to the central nervous system. The inhibition of the nociceptive impulse may decrease the occurrence of muscle spasm following mobilization postoperatively. This mechanism may contribute to a better functional recovery following upper limb surgery. This systematic review will investigate the impact of peripheral nerve block on functional recovery after an upper limb surgery. Methods We will search studies comparing peripheral nerve block to general anesthesia for upper limb surgery in the following databases: CENTRAL, MEDLINE (Ovid), CINAHL, EMBASE, and Scopus. In duplicate, independent reviewers will assess eligibility, evaluate risk of bias, and abstract data on type of peripheral nerve block and functional outcome. Where possible, we will pool results using a random effects model. For each outcome, we will assess the quality of evidence using GRADE methodology. Discussion We aim to summarize the available evidence comparing functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery. These data will inform the design of a trial on the topic. Systematic review registration PROSPERO CRD42018116298

scholarly journals Effects of Anesthetic Techniques on the Risk of Postoperative Complications Following Lower Extremity Amputation in Diabetes Patients with Coagulation Abnormalities: A Retrospective Cohort Study Using Propensity Score Analysis

2021 ◽  
Vol 10 (23) ◽  
pp. 5598
Author(s):  
Hye Jin Kim ◽  
Chun-Gon Park ◽  
Yong Seon Choi ◽  
Yong Suk Lee ◽  
Hyun-Jeong Kwak
Keyword(s):  
Postoperative Complications ◽  
Lower Extremity ◽  
General Anesthesia ◽  
Diabetic Foot ◽  
Odds Ratio ◽  
Lower Extremity Amputation ◽  
Coagulation Abnormalities ◽  
Number Of Patients ◽  
Extremity Amputation ◽  
Diabetes Patients

Diabetic foot amputation is associated with high morbidity and mortality rates. To prevent cardiovascular complications along with vasculopathy in the course of diabetes mellitus, a high number of patients receive anticoagulant therapy. However, anticoagulants are contraindicated in neuraxial anesthesia limiting available anesthetic modalities. Therefore, in this retrospective study, we aimed to compare between general anesthesia and peripheral nerve block (PNB) with respect to postoperative complications following lower extremity amputation (LEA) in patients with coagulation abnormalities. In total, 320 adult patients who underwent LEA for diabetic foot were divided into two groups according to the anesthetic type (general anesthesia vs. PNB). The inverse probability of treatment weighting was performed to balance the baseline patient characteristics and surgical risk between the two groups. The adjusted analysis showed that compared with the general anesthesia group, the PNB group had lower risks of pneumonia (odds ratio: 0.091, 95% confidence interval [CI]: 0.010–0.850, p = 0.0355), acute kidney injury (odds ratio: 0.078, 95% CI: 0.007–0.871, p = 0.0382), and total major complications (odds ratio: 0.603, 95% CI: 0.400–0.910, p = 0.0161). Additionally, general anesthesia was associated with a higher amount of intraoperative crystalloid administration and a requirement for more frequent vasopressors. In conclusion, PNB appears to be protective against complications following LEA in diabetes patients with coagulopathy.

scholarly journals Combination of general anesthesia and peripheral nerve block with low-dose ropivacaine reduces postoperative pain for several days after outpatient arthroscopy

Medicine ◽  
2017 ◽  
Vol 96 (6) ◽  
pp. e6046 ◽  
Author(s):  
Benedikt Büttner ◽  
Ashham Mansur ◽  
José Hinz ◽  
Joachim Erlenwein ◽  
Martin Bauer ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Peripheral Nerve ◽  
General Anesthesia ◽  
Nerve Block ◽  
Low Dose ◽  
Peripheral Nerve Block

scholarly journals Comparative of the Effectiveness of Different Objective Method for Infraclavicular Brachial Plexus Block Success; Which One of Them is A Reliable and Early Indicator?

2021 ◽  
Author(s):  
Abdulhakim Sengel ◽  
Mahmut alp Karahan ◽  
Nuray Altay ◽  
Orhan Binici ◽  
Veli fahri Pehlivan ◽  
...  
Keyword(s):  
Body Temperature ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Temperature Measurements ◽  
Tissue Oxygen Saturation ◽  
Block Success ◽  
Significant Difference ◽  
Plexus Block ◽  
Tissue Hemoglobin

ABSTRACT BACKGROUND Traditional methods that evaluate the success of peripheral nerve block have been replaced by methods that allow objective evaluations over time. Multiple objective techniques for peripheral nerve block have been discussed in the literature. OBJECTIVE This study aims to investigate whether perfusion index (PI), non-invasive tissue hemoglobin monitoring (SpHb), tissue oxygen saturation (StO2), tissue hemoglobin index (THI) and body temperature are reliable and objective methods to evaluate the adequacy of infraclavicular blockage. DESIGN A prospective observational study. SETTING Single center, Department of Anesthesiology, Harran University Medical Faculty, Turkey, from February 2019 to December 2019. PATIENTS A total of 100 patients scheduled to undergo forearm surgery. INTERVENTION Ultrasound-guided infraclavicular block (ICB) in 100 patients undergoing forearm surgery. MAIN OUTCOME MEASURES PI, SpHb, StO2, THI and Body Temperature measurements were recorded 5 min before the block procedure, right after the procedure, and until the 25th minute after the procedure at 5-min intervals. These values were compared between the blocked limbs and non-blocked limbs while being statistically compared between the successful and failed block groups. RESULTS Although there were significant differences between the groups of blocked extremity and non-blocked extremity in terms of StO2 (P = 0.001), THI (P = 0.001), PI (P = 0.001) and body temperature (P = 0.001), there was no significant difference between these groups in terms of SpHb (P > 0.05). Moreover, a significant difference was detected between the groups of successful block and failed block in terms of StO2 (P = 0.002), PI (P = 0.002) and body temperature (P = 0.005), while there was no significant difference between these groups in terms of THI (P > 0.05) and SpHb (P > 0.05). CONCLUSION StO2, PI and body temperature measurements are the simple, objective, noninvasive techniques to be used to evaluate success of block procedures. According to The receiver operating characteristic (ROC) analysis, StO2 is the specific parameter with the highest sensitivity among these parameters.

Sign in / Sign up

Export Citation Format

Share Document