scholarly journals Workup and Management of Persistent Neuralgia following Nerve Block

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Paul David Weyker ◽  
Christopher Allen-John Webb ◽  
Thoha M. Pham
Keyword(s):  
Magnetic Resonance ◽  
Sciatic Nerve ◽  
Nerve Block ◽  
Magnetic Resonance Neurography ◽  
Nerve Blocks ◽  
Duration Of Symptoms ◽  
Peripheral Nerve Blocks ◽  
Nonopioid Analgesics ◽  
Sciatic Nerves ◽  
Neurological Injuries

Neurological injuries following peripheral nerve blocks are a relatively rare yet potentially devastating complication depending on the type of lesion, affected extremity, and duration of symptoms. Medical management continues to be the treatment modality of choice with multimodal nonopioid analgesics as the cornerstone of this therapy. We report the case of a 28-year-old man who developed a clinical common peroneal and lateral sural cutaneous neuropathy following an uncomplicated popliteal sciatic nerve block. Workup with electrodiagnostic studies and magnetic resonance neurography revealed injury to both the femoral and sciatic nerves. Diagnostic studies and potential mechanisms for nerve injury are discussed.

scholarly journals Nerve Stimulator-guided Supplemental Popliteal Sciatic Nerve Block after a Failed Sciatic Block Does Not Increase the Incidence of Transient Postoperative Neurologic Sequelae

2011 ◽  
Vol 115 (3) ◽  
pp. 596-603 ◽  
Author(s):  
Antoun Nader ◽  
Mark C. Kendall ◽  
Robert Doty ◽  
Alexander DeLeon ◽  
Edward Yaghmour ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Sciatic Nerve Block ◽  
Cumulative Exposure ◽  
Nerve Blocks ◽  
Duration Of Symptoms ◽  
Neurologic Symptoms ◽  
Neurologic Sequelae ◽  
Distal Site

Background Supplemental peripheral nerve blocks are not commonly performed in adults because of concerns of cumulative exposure of the nerve to the local anesthetic as well as increased ischemia from epinephrine. The purpose of this study was to compare the incidence of postoperative neurologic symptoms after a failed subgluteal sciatic nerve block and a supplemental popliteal sciatic nerve block. Methods Five hundred twelve adult patients undergoing ambulatory surgery were prospectively studied (1 yr). Sciatic nerve blocks were performed using levobupivacaine 0.625% with epinephrine 1:200,000 (0.5 ml/kg). Patients who failed to achieve sensory and motor anesthesia at 30-60 min were given a popliteal sciatic nerve block (lidocaine 2% 10 ml + levobupivacaine 0.5% 10 ml). Subjects were contacted at 24 h to 48 h, 2 weeks, and 1 month. Symptomatic patients were contacted biweekly and reevaluated during follow-up surgeon visits until symptom resolution. Results Four hundred thirty-nine subjects were analyzed. Fifty-six received a popliteal sciatic nerve block. Four subjects (0.9%) had self-reported neurologic symptoms in the distribution of the sciatic nerve. Investigator-initiated follow-up revealed 33 subjects (8.7%) who received a single subgluteal sciatic block and 4 subjects (7.1%) after a supplemental sciatic nerve block with neurologic symptoms (P = 0.80). The median duration of symptoms was 4 weeks (95% CI 3-5) in the subgluteal and 4 weeks (95% CI 3-5) weeks in the popliteal group (P = 0.98). All symptoms resolved by 14 weeks postprocedure. Conclusion Blocking the sciatic nerve at a more distal site after a failed subgluteal sciatic nerve block does not appear to influence the incidence or duration of neurologic sequelae.

scholarly journals Addition of dexmedetomidine to QX-314 enhances the onset and duration of sciatic nerve block in rats

2018 ◽  
Vol 96 (4) ◽  
pp. 388-394 ◽  
Author(s):  
Wenling Zhao ◽  
Qinqin Yin ◽  
Jin Liu ◽  
Wensheng Zhang ◽  
Linghui Yang
Keyword(s):  
Sciatic Nerve ◽  
Motor Function ◽  
Nerve Block ◽  
Action Potentials ◽  
Sciatic Nerve Block ◽  
Nerve Blocks ◽  
Thermal Nociception ◽  
Compound Action Potentials ◽  
Sciatic Nerves ◽  
Compound Action

An experimental set-up was designed to observe whether adding dexmedetomidine to QX-314 would enhance the onset and duration of sensory and motor function in a rat sciatic nerve block model. Fifty-six Sprague-Dawley rats received unilateral sciatic nerve blocks with 0.2 mL of 35 mmol/L QX-314 alone, dexmedetomidine (5.3 μmol/L (1 μg/kg), 26.4 μmol/L (5 μg/kg), 52.8 μmol/L (10 μg/kg)) alone, or a combination of the two. Thermal nociception and motor function were assessed by an investigator blinded to the drug treatment, and sciatic nerves and perineural tissues were harvested at 14 days after injection. In addition, we examined the effects of these solutions on compound action potentials in isolated frog sciatic nerves. Dexmedetomidine added to QX-314 enhanced the onset and duration of thermal nociception block and motor block (P < 0.05) without aggravating histopathological injuries. Furthermore, 52.8 μmol/L dexmedetomidine added to 35 mmol/L QX-314 showed less inflammation than QX-314 alone at 14 days (P = 0.003). Dexmedetomidine plus QX-314 was shown to dose-dependently reduce the compound action potentials relative to QX-314 alone (P < 0.05). It was concluded that co-administration of QX-314 with a clinical dose of dexmedetomidine produced a synergistic anesthetic effect to enhance the effect of sciatic nerve block.

Assessment of sciatic nerve block success with elastography: new perspective for the nerve blocks

2021 ◽  
Vol 87 (12) ◽  
Author(s):  
Muhammet A. KARAKAYA ◽  
Ilker INCE ◽  
Osman B. KUCUKERDEM ◽  
Ali BAS ◽  
Yavuz GURKAN
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Sciatic Nerve Block ◽  
Nerve Blocks ◽  
Block Success ◽  
New Perspective

Morphological correlates of oxaliplatin induced peripheral neuropathy assessed by magnetic resonance neurography.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10092-10092
Author(s):  
Leonidas Apostolidis ◽  
Daniel Schwarz ◽  
Annie Xia ◽  
Markus Weiler ◽  
Sabine Heiland ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Magnetic Resonance ◽  
Sciatic Nerve ◽  
Qualitative Evaluation ◽  
Magnetic Resonance Neurography ◽  
Imaging Protocol ◽  
Morphological Alterations ◽  
Patient Reported ◽  
Neuroprotective Strategies

10092 Background: Oxaliplatin induced peripheral neuropathy (OXA-PNP) is a frequent side effect of oxaliplatin containing chemotherapy protocols. It is commonly assessed clinically via physical examination and patient reported symptoms. Research has been impeded by the lack of objective tests to quantify OXA-PNP. Neurophysiological examination is time-consuming and can only cover a selected part of the examined nerve. The aim of this study was to investigate in-vivo morphological correlates of OXA-PNP by magnetic resonance neurography (MRN). Methods: 20 patients with mild to moderate OXA-PNP and 20 matched controls were prospectively enrolled. All patients underwent a detailed neurophysiology examination prior to neuroimaging. A standardized MRN imaging protocol at 3.0 Tesla with large-coverage included the lumbosacral plexus, as well as both sciatic nerves and their branches using T2-weighted fat-saturated sequences at high resolution. Qualitative evaluation of sciatic, tibial, and peroneal nerves were performed by two readers regarding the presence, degree, and distribution of nerve lesions. Quantitative assessment included volumetry of the dorsal root ganglia (DRG) and sciatic nerve normalized T2 (nT2) signal and caliber. Results: Significant DRG hypertrophy in OXA-PNP patients (207.3±47.7mm3 vs. 153.0±47.1mm3 in controls, p = 0.001) was found as morphological correlate of the sensory neuronopathy. Peripheral nerves only exhibited slight morphological alterations qualitatively. Quantitatively, sciatic nerve caliber was unchanged (26.0±5.1mm2 vs. 27.4±7.4mm2, p = 0.19) while sciatic nerve nT2 signal was slightly and non-significantly elevated in patients (1.32±0.22 vs. 1.22±0.26, p = 0.19). Conclusions: OXA-PNP leads to morphological correlates that can be detected in-vivo by MRN. Significant hypertrophy of the DRG was observed, a phenomenon which has not been described in OXA-PNP previously. DRG volume should be investigated as a biomarker in other sensory peripheral neuropathies and ganglionopathies as well as in studies evaluating neuroprotective strategies for OXA-PNP.

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.

scholarly journals Defining the minimal effective volume and amount of lidocaine to perform a femoral nerve block under ultrasound control

2020 ◽  
Author(s):  
Valery Piacherski ◽  
Aliaksei Marachkou
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Local Anesthetics ◽  
Peripheral Nerves ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
The Body ◽  
Effective Volume ◽  
Nerve Blocks ◽  
Nerve Blockade

Abstract BackgroundThe application of the combination of local anesthetics (LA) in some parts of the body increases the amount of LA and plasma concentration. The aim of our research was to define the minimal effective volume and amount of lidocaine with added adrenaline (1:200,000) to perform a femoral nerve block under ultrasound control and with neurostimulation. MethodsFemoral nerve blockade was performed with the following lidocaine solutions: 0.75% -10 ml, 7.5 ml; 1% -20ml, 15ml, 10ml, 7.5ml, 5ml; 1.5% -5ml, 4ml; 2% -5 ml, 4 ml; 3% -5ml, 4ml, 3ml; 4% -5 ml, 4 ml, 3 ml, 2.5 ml. All blocks were performed with added adrenaline (1:200,000). In all, 181 blocks of the femoral nerve, in combination with sciatic nerve blocks, were carried out with the help of the electrostimulation of peripheral nerves, and under ultrasound. The quality of motor and sensory blocks was assessed after 45 min of administration of the femoral nerve block. ResultsA total of 181 femoral nerve blocks, in combination with sciatic nerve blocks, were used via the help of electrostimulation of the peripheral nerves (EPN), and under ultrasound (US) control. The femoral nerve blockade was effective with the following lidocaine solutions: 0.75% -10 ml (75mg); 1% -20ml, 15ml, 10ml, 7.5ml (75mg); 1.5% -5ml (75mg); 2% -5 ml (100 mg); 3% -5ml (150mg); 4% -5 ml (200mg). Femoral blockade was ineffective when using the following solutions of lidocaine: 0.75% - 7.5ml (56.25 mg); 1% - 5ml (50mg); 1.5% - 4ml (60mg, No spread along the entire circumference of the nerve - NSAECN); 2% - 4 ml (80mg, NSAECN); 3% - 4ml (120mg NSAECN), 3 ml; 4% - 4 ml (160 mg, NSAECN), 3 ml, 2.5 ml. ConclusionFor a complete motor and sensory block of the femoral nerve: the minimum effective volume of local anesthetics was 5 ml; and the minimum effective amount of lidocaine was 75 mg. А complete block of the femoral nerve was achieved only with the spreading of local anesthetic along the whole circumference of the femoral nerve.

scholarly journals Effect of Anaesthesiologists’ Experience on Preferred Technique and Volume of Local Anaesthetic Administered for Brachial Plexus Nerve Block: A Retrospective Observational Analysis

2021 ◽  
Author(s):  
Depinder Kaur ◽  
Reena Mahajan ◽  
Shiv Kumar Singh ◽  
Suchitra Malhotra
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Failure Rate ◽  
Nerve Block ◽  
Local Anaesthetic ◽  
Block Group ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Group A ◽  
Group B

Introduction: Faculty and Residents are trained in peripheral nerve blocks guided by blind technique, Peripheral Neuro Stimulator (PNS) or Ultrasound (USG) guided technique. But due to unavailability of USG machine in all institutes and requiring special training, techniques used for peripheral nerve blocks vary from institute to institute. Aim: To analyse the effect of anaesthesiologists’ experience on preferred technique and Local Anaesthetic (LA) volume used for brachial plexus nerve block retrospectively. Materials and Methods: In this retrospective observational study, 129 adults American Society of Anesthesiologists (ASA) grade I and II patients requiring brachial plexus nerve block for upper limb orthopaedic surgical anaesthesia for both elective and emergency surgery were divided into three groups for each year depending on technique for nerve block used. Group A: Received USG guided (Micromaxx Sonosite Inc, USA) brachial plexus nerve block. Group B: Received peripheral nerve stimulator (Inmed) guided brachial plexus nerve block. Group C: Received brachial plexus nerve block by traditional anatomical landmark based paraesthesia elicitation blind technique. Patients with inadequate surgical analgesia were given general anaesthesia and were categorised as failure rate. Year wise demographic data, type of technique used for giving brachial plexus nerve block, volume of drug used, failure rate, complications observed were collected and analysed by Student’s t-test and Chi-square test. Results: USG guided technique was the most prefered technique in both years (57.6%, n=38 in year 2018 and 49.2%, n=31 in year 2019). In remaining nearly half of the patients PNS and blind technique was used (PNS 24.2%, n=16 in year 2018 and 20.6%, n=13 in year 2019; blind technique 18.2%, n=12 in year 2018 and 30.2%, n=19 in year 2019). Significantly, less volume of LA drug (mL) was used in group A in year 2019 (16.43±6.07) than in year 2018 (22.34±4.75) (p<0.001). Failure rate in group A in year 2019 (3.2%) was significantly less than in year 2018 (5.2%), but the difference was insignificant in all three groups. In group A, no complications were observed in year 2019 while one incidence of hemidiaphragm paralysis was observed in year 2018, while in group B and C, complications were observed in both years. Conclusion: USG guided nerve block was the most preferred technique for nerve block in the study institute. In 24 months observation period, with increasing experience with USG there was significant increase in success rate and decrease in the volume of LA administered and complications.

scholarly journals Comparison of sciatic nerve block quality achieved using the anterior and posterior approaches: A randomised trial

2019 ◽  
Author(s):  
Abdulkadir Yektaş ◽  
Bedih Balkan
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Diclofenac Sodium ◽  
Randomised Trial ◽  
Femoral Nerve ◽  
Operation Time ◽  
Sciatic Nerve Block ◽  
Nerve Blocks ◽  
Posterior Group ◽  
Group A

Abstract Background: The co-administration of sciatic and femoral nerve blocks can provide anaesthesia and analgesia in patients undergoing lower extremity surgeries. Several approaches to achieve sciatic nerve block have been described, including anterior and posterior approaches. Methods: In total, 58 study patients were randomly assigned to receive either anterior (group A, n=29) or posterior (group P, n=29) sciatic nerve block. Thereafter, the following parameters were determined: sensory and motor block start and end times, time to first fentanyl requirement after blockade but before the start of the operation, time to first fentanyl requirement after the start of the operation, mean fentanyl dose administered after blockade but before the start of the operation, mean fentanyl dose after the start of the operation, time to first diclofenac sodium dose, and total dose of diclofenac sodium required. The trial was retrospectively registered on 11 July 2018. Results: The time to initiation of sensory block was significantly shorter in group P than in group A (7.70±2.05 min and 12.88±4.87 min, respectively; p=0.01). Group P also had a significantly shorter time to first fentanyl requirement after block but before the start of the operation (00.00±00.00 min for group P and 4.05±7.47 min for group A; p<0.01), significantly higher mean fentanyl dose per patient after block but before the start of the operation (44.03±23.78 µg for group P and 31.20±27.79 µg for group A), significantly longer time to first fentanyl requirement after the start of the operation (16.24±7.13 min for group P and 00.00±00.00 min for group A; p=0.01), and significantly lower mean fentanyl dose per patient after the start of the operation (11.51±2.87 µg for group P and 147.75±22.30 µg for group A). Patient satisfaction (p<0.01), anaesthesia quality (p=0.006), and surgical quality (p=0.047) were significantly higher in group P. Conclusions: Anterior and posterior approaches can be used to achieve sciatic nerve block in patients undergoing surgery for malleolar fractures. However, better anaesthesia and pain control results can be obtained if analgesia is administered preoperatively in patients with a posterior approach block and after the start of the operation in patients with an anterior approach block.

scholarly journals Perineural Dexmedetomidine Added to Ropivacaine Causes a Dose-dependent Increase in the Duration of Thermal Antinociception in Sciatic Nerve Block in Rat

2009 ◽  
Vol 111 (5) ◽  
pp. 1111-1119 ◽  
Author(s):  
Chad M. Brummett ◽  
Amrita K. Padda ◽  
Francesco S. Amodeo ◽  
Kathleen B. Welch ◽  
Ralph Lydic
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Sensory Function ◽  
Dose Effect ◽  
High Dose ◽  
Thermal Stimulus ◽  
Nerve Blocks ◽  
Sensory Blockade ◽  
Dose Dependent Fashion ◽  
Dose Dependent

Background The current study was designed to test the hypothesis that dexmedetomidine added to ropivacaine would increase the duration of antinociception to a thermal stimulus in a dose-dependent fashion in a rat model of sciatic nerve blockade. Methods Fifty adult Sprague-Dawley rats (10 rats/group) received unilateral sciatic nerve blocks with 0.2 ml ropivacaine (0.5%) or 0.2 ml ropivacaine (0.5%) plus dexmedetomidine (2.7 microm [0.5 microg/kg], 11.7 microm [2 microg/kg], 34.1 microm [6 microg/kg], or 120.6 microm [20 microg/kg]) in a randomized, blinded fashion. Time to paw withdrawal latency to a thermal stimulus for both paws and an assessment of motor function were measured every 30 min after the nerve block until a return to baseline. Results Dexmedetomidine added to ropivacaine increased the duration of dense sensory blockade and time for return to normal sensory function in a dose-dependent fashion (P &lt; 0.005). There was a significant time (P &lt; 0.005), dose (P &lt; 0.005), and time-by-dose effect (P &lt; 0.005) on paw withdrawal latencies of the operative paws. There were no significant differences in paw withdrawal latencies of the control paws, indicating little systemic effect of the dexmedetomidine. The duration of motor blockade was also increased with dexmedetomidine. High-dose dexmedetomidine (120.6 mum) was not neurotoxic. Conclusion This is the first study showing that dexmedetomidine added to ropivacaine increases the duration of sensory blockade in a dose-dependent fashion in rats. The findings are an essential first step encouraging future efficacy studies in humans.

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