Variation in pediatric local anesthetic dosing for peripheral nerve blocks: an analysis from the Pediatric Regional Anesthesia Network (PRAN)

2020 ◽  
Vol 45 (12) ◽  
pp. 964-969 ◽  
Author(s):  
Andreas H Taenzer ◽  
Michael Herrick ◽  
Matthew Hoyt ◽  
R J Ramamurthi ◽  
Benjamin Walker ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Local Anesthetic ◽  
Age Groups ◽  
Geographic Location ◽  
Average Weight ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Increased Risk ◽  
The Mean

BackgroundVariation of local anesthetic dosing has been reported for adult peripheral nerve blocks (PNBs) and infant caudal blocks. As higher doses of local anesthetics (LA) are potentially associated with increased risk of complications (eg, local anesthetic systemic toxicity), it is important to understand the source of LA dose variation. Using the Pediatric Regional Anesthesia Network (PRAN) database, we aimed to determine if variation in dosing exists in pediatric single-injection PNBs, and what factors influence that variation.The primary aim of this study was to determine the factors associated with dosing for the 10 most commonly performed PNBs, with the secondary aim of exploring possible factors for variation such as number of blocks performed versus geographic location.MethodsThe PRAN database was used to determine the 10 most common pediatric PNBs, excluding neuraxial regional anesthetics. The 10 most common pediatric PNBs in the PRAN database were analyzed for variation of LA dose and causes for variation.ResultsIn a cohort of 34 514 children receiving PNBs, the mean age was 10.38 (+/-5.23) years, average weight was 44.88 (+/-26.66) kg and 61.8% were men. The mean bupivacaine equivalent (BE) dose was 0.86 (+/-0.5) mg kg−1 and ropivacaine was used in 65.4% of blocks. Dose decreases with age (estimate −0.016 (−0.017, –0.015; p<0.001)). In all blocks for all age groups, the range of doses that make up the central 80% of all doses exceeds the mean BE dose for the block. Variation is not related to the number blocks performed at an institution (p=0.33 (CI −0.42 to 0.15)). The dose administered for a PNB is driven in order of impact by the institution where the block was performed (Cohen’s ƒ=0.45), then by weight (0.31), type of block (0.27), LA used (0.15) and age (0.03).ConclusionsConsiderable variation in dosing exists in all age groups and in all block types. The most impactful driver of local anesthetic dose is the institution where the block was performed, indicating the dosing of a potentially lethal drug is more based on local culture than on evidence.

Local anesthetic ‘in-situ’ toxicity during peripheral nerve blocks

2012 ◽  
Vol 25 (5) ◽  
pp. 589-595 ◽  
Author(s):  
Karine Nouette-Gaulain ◽  
Xavier Capdevila ◽  
Rodrigue Rossignol
Keyword(s):  
Peripheral Nerve ◽  
Local Anesthetic ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks

scholarly journals Ultrasound Guidance for Deep Peripheral Nerve Blocks: A Brief Review

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Anupama Wadhwa ◽  
Sunitha Kanchi Kandadai ◽  
Sujittra Tongpresert ◽  
Detlef Obal ◽  
Ralf Erich Gebhard
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Stimulation ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Sense Of Security ◽  
False Sense ◽  
Anesthesia Technique ◽  
Additional Value

Nerve stimulation and ultrasound have been introduced to the practice of regional anesthesia mostly in the last two decades. Ultrasound did not gain as much popularity as the nerve stimulation until a decade ago because of the simplicity, accuracy and portability of the nerve stimulator. Ultrasound is now available in most academic centers practicing regional anesthesia and is a popular tool amongst trainees for performance of nerve blocks. This review article specifically discusses the role of ultrasonography for deeply situated nerves or plexuses such as the infraclavicular block for the upper extremity and lumbar plexus and sciatic nerve blocks for the lower extremity. Transitioning from nerve stimulation to ultrasound-guided blocks alone or in combination is beneficial in certain scenarios. However, not every patient undergoing regional anesthesia technique benefits from the use of ultrasound, especially when circumstances resulting in difficult visualization such as deep nerve blocks and/or block performed by inexperienced ultrasonographers. The use of ultrasound does not replace experience and knowledge of relevant anatomy, especially for visualization of deep structures. In certain scenarios, ultrasound may not offer additional value and substantial amount of time may be spent trying to find relevant structures or even provide a false sense of security, especially to an inexperienced operator. We look at available literature on the role of ultrasound for the performance of deep peripheral nerve blocks and its benefits.

Relative Contribution of Adjuvants to Local Anesthetic for Prolonging the Duration of Peripheral Nerve Blocks in Rats

2016 ◽  
Vol 41 (5) ◽  
pp. 589-592 ◽  
Author(s):  
Asokumar Buvanendran ◽  
Jeffrey S. Kroin ◽  
Jinyuan Li ◽  
Mario Moric ◽  
Kenneth J. Tuman
Keyword(s):  
Peripheral Nerve ◽  
Local Anesthetic ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Relative Contribution

scholarly journals Continuous Versus Single-Injection Peripheral Nerve Blocks: A Prospective Cohort Study Comparing Procedural Time and Estimated Personnel Cost

2015 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Brendan Carvalho ◽  
Romy D. Yun ◽  
Edward R. Mariano
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Single Injection ◽  
Clinical Care ◽  
Personnel Cost ◽  
Additional Time ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Physician Time

Background and Objectives: Continuous peripheral nerve blocks (CPNB) provide many additional benefits compared to single-injection peripheral nerve blocks (SPNB). However, the time and costs associated with CPNB provision have not been previously considered. The objective of this study was to compare the time required and estimated personnel costs associated with CPNB and SPNB. Methods: This IRB-exempt observational study involved provision of preoperative regional anesthesia procedures in a “block room” model by a dedicated team during routine clinical care. The primary outcome, the time to perform ultrasound-guided popliteal-sciatic blocks, was recorded prospectively. This time measurement was broken down into individual tasks: time to place monitors, prepare the equipment, scan and identify the target, perform the block, and clean up post-procedure. For peripheral nerve block catheters, time to insert, locate, and secure the catheter was also recorded. Cost estimates for physician time were determined using published national mean hourly wages. Results: Time measurements were recorded for 24 nerve block procedures (12 CPNB and 12 SPNB). The median (IQR; range) total time (seconds) taken to perform blocks was 1132 (1083-1290; 1060-1623) for CPNB versus 505 (409-589; 368-635) for SPNB (Table 1; p<0.001). The median (IQR) cost attributed to physician time during block performance was $35.20 ($33.66-$40.11) and $15.69 ($12.73-$18.32) for CPNB and SPNB, respectively. Conclusion: CPNB requires approximately 10 more minutes per procedure to perform when compared to SPNB. This additional time should be considered along with potential patient benefits and available resources when developing a regional anesthesia and acute pain medicine service.

Peripheral Nerve Blocks in a Regional Anesthesia Block Area

2018 ◽  
Vol 43 (4) ◽  
pp. 448-449 ◽  
Author(s):  
Joselo D. Macachor ◽  
Chandra M. Kumar ◽  
Edwin Seet ◽  
Leng Zoo Tan
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Block Area
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