Combined ultrasound and nerve stimulator-guided deep nerve block may decrease the rate of local anesthetics systemic toxicity: a randomized clinical trial

Abstract Background: Ultrasound guidance might decrease the incidence of local anesthetics systemic toxicity (LAST) for many peripheral nerve blocks compared with nerve stimulator guidance. However, it remains uncertain whether ultrasound guidance is superior to nerve stimulator guidance for deep nerve block of the lower extremity. This study was designed to investigate whether deep nerve block with ultrasound guidance would decrease the incidence of LAST compared with that with nerve stimulator guidance and to identify associated risk factors of LAST. Methods: Three hundred patients undergoing elective lower limb surgery and desiring lumbar plexus blocks (LPBs) and sciatic nerve blocks (SNBs) were enrolled in this study. The patients were randomly assigned to receive LPBs and SNBs with ultrasound guidance (group U), nerve stimulator guidance (group N) or dual guidance (group M). The primary outcome was the incidence of LAST. The secondary outcomes were the number of needle redirections, motor and sensory block onset and nerve distribution restoration time, as well as associated risk factors. Results: There were 18 patients with LAST, including 12 in group U, 4 in group N and 2 in group M. By multiple comparisons among the three 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 hepatitis B (HBV) infection and the female sex 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: Ultrasound guidance, HBV infection and the female sex were risk factors of LAST with LPBs and SNBs. For patients infected with HBV or female patients receiving LPBs and SNBs, we recommended that combined ultrasound and nerve stimulator guidance should be used to improve the safety. Trial registration: This study was approved by the Ethical Committee of the First Affiliated Hospital of Army Medical University. The protocol was registered prospectively with the Chinese Clinical Trial Registry (ChiCTR-IOR-16008099) on March 15, 2016.

Download Full-text

Combined Ultrasound and Nerve Stimulator-Guided Deep Nerve Block May Decrease the Rate of Local Anesthetics Systemic Toxicity: A Randomized Clinical Trial

10.21203/rs.2.185/v4 ◽

2019 ◽

Author(s):

Xu-hao Zhang ◽

Yu-jie Li ◽

Wenquan He ◽

Chunyong Yang ◽

Jianteng Gu ◽

...

Keyword(s):

Risk Factors ◽

Clinical Trial ◽

Nerve Block ◽

Local Anesthetics ◽

Ultrasound Guidance ◽

Systemic Toxicity ◽

Hbv Infection ◽

Nerve Stimulator ◽

Nerve Blocks ◽

Associated Risk Factors

Abstract Background: Ultrasound guidance might decrease the incidence of local anesthetics systemic toxicity (LAST) for many peripheral nerve blocks compared with nerve stimulator guidance. However, it remains uncertain whether ultrasound guidance is superior to nerve stimulator guidance for deep nerve block of the lower extremity. This study was designed to investigate whether deep nerve block with ultrasound guidance would decrease the incidence of LAST compared with that with nerve stimulator guidance and to identify associated risk factors of LAST. Methods: Three hundred patients undergoing elective lower limb surgery and desiring lumbar plexus blocks (LPBs) and sciatic nerve blocks (SNBs) were enrolled in this study. The patients were randomly assigned to receive LPBs and SNBs with ultrasound guidance (group U), nerve stimulator guidance (group N) or dual guidance (group M). The primary outcome was the incidence of LAST. The secondary outcomes were the number of needle redirections, motor and sensory block onset and nerve distribution restoration time, as well as associated risk factors. Results: There were 18 patients with LAST, including 12 in group U, 4 in group N and 2 in group M. By multiple comparisons among the three 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 hepatitis B (HBV) infection and the female sex 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: Ultrasound guidance, HBV infection and the female sex were risk factors of LAST with LPBs and SNBs. For patients infected with HBV or female patients receiving LPBs and SNBs, we recommended that combined ultrasound and nerve stimulator guidance should be used to improve the safety. Trial registration: This study was approved by the Ethical Committee of the First Affiliated Hospital of Army Medical University. The protocol was registered prospectively with the Chinese Clinical Trial Registry (ChiCTR-IOR-16008099) on March 15, 2016.

Download Full-text

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

10.21203/rs.2.185/v1 ◽

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

Download Full-text

Combined Ultrasound and Nerve Stimulator-Guided deep nerve block may decrease the rate of local anesthetics systemic toxicity especially in HBV carriers: A Randomized clinical trial

10.21203/rs.2.185/v2 ◽

2019 ◽

Author(s):

Xu-hao Zhang ◽

Yu-jie Li ◽

Wenquan He ◽

Chunyong Yang ◽

Jianteng Gu ◽

...

Keyword(s):

Risk Factors ◽

Clinical Trial ◽

Nerve Block ◽

Local Anesthetics ◽

Ultrasound Guidance ◽

Female Gender ◽

Hbv Infection ◽

Nerve Stimulator ◽

Nerve Blocks ◽

Associated Risk Factors

Abstract Background: Ultrasound-guidance might decrease the incidence of local anesthetics systemic toxicity(LAST) for many peripheral nerve blocks compared with nerve stimulator-guidance. However, it remained uncertain whether ultrasound-guidance would be superior to the nerve stimulator-guidance for deep nerve block in the lower extremity. This study was designed to investigate that whether ultrasound-guided deep nerve block would decrease the incidence of LAST comparing with those with nerve stimulator-guidance, and to find out associated risk factors for LAST. Methods: Three hundred patients 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 LPBs and SNBs with ultrasound-guidance (Group U), nerve stimulator-guidance (Group N) or dual-guidance (Group M). The primary outcome was the incidence of the LAST. The secondary outcomes were the number of needle redirection, motor and sensory block onset and restoration time in the nerve distributions, and associated risk factors. Results: There were 18 patients occurring with LAST, including 12 in group U, 4 in group N and 2 in group M. For multiple comparisons among the three 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 hepatitis B （HBV） infection and female gender were 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: Ultrasound-guidance, HBV infection and female gender were risk factors for LAST in LPBs and SNBs. For patients with HBV infection or female gender undergoing LPBs and SNBs, we recommended that combined ultrasound and nerve stimulator-guidance should be used to improve the safety. Trial registration: This study was approved by the Ethical Committee from the first affiliated hospital of Army Medical University. The protocol was registered prospectively with Chinese Clinical Trial Registry (ChiCTR-IOR-16008099) on March 15th，2016. Key words: ultrasound; nerve stimulation; nerve block; female; HBV; LAST

Download Full-text

Effectiveness of Buccal Infiltration and Inferior Alveolar Nerve Block With Articaine for Extraction of Mandibular Teeth- A Randomized Clinical Trial

Case Medical Research ◽

10.31525/ct1-nct04294745 ◽

2020 ◽

Author(s):

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Nerve Block ◽

Inferior Alveolar Nerve ◽

Inferior Alveolar Nerve Block ◽

Mandibular Teeth ◽

Buccal Infiltration

Download Full-text

Faculty Opinions recommendation of Comparison of success rate of ultrasound-guided sciatic and femoral nerve block and neurostimulation in children with arthrogryposis multiplex congenita: a randomized clinical trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717958770.793463034 ◽

2012 ◽

Author(s):

Jan Jakobsson

Keyword(s):

Clinical Trial ◽

Success Rate ◽

Randomized Clinical Trial ◽

Nerve Block ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Arthrogryposis Multiplex Congenita ◽

Ultrasound Guided

Download Full-text

Tolerability of Prostate Transrectal Biopsies Using Gel and Local Anesthetics: Results of a Randomized Clinical Trial

Journal of Endourology ◽

10.1089/end.2005.19.738 ◽

2005 ◽

Vol 19 (6) ◽

pp. 738-743 ◽

Cited By ~ 17

Author(s):

Andrea B. Galosi ◽

Daniele Minardi ◽

Lucio Dell'Atti ◽

Mamhoud Yehia ◽

Giovanni Muzzonigro

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Local Anesthetics

Download Full-text

The Effect of Subcutaneous and Intraperitoneal Instillation of Local Anesthetics on Postoperative Pain after Laparoscopic Varicocelectomy: A Randomized Controlled Trial

Children ◽

10.3390/children8111051 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1051

Author(s):

Zenon Pogorelić ◽

Tea Gaberc ◽

Miro Jukić ◽

Goran Tintor ◽

Ana Nevešćanin Biliškov ◽

...

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Pain Intensity ◽

Randomized Clinical Trial ◽

Local Anesthetic ◽

Local Anesthetics ◽

Control Group ◽

Number Of Patients ◽

Intraperitoneal Instillation ◽

Time Point

Background: The main goal of the present randomized clinical trial was to investigate the effects of subcutaneous administration of two different local anesthetics at trocar incision sites at the abdominal wall in combination with intraoperative intraperitoneal instillation of local anesthetics, on the character of postoperative pain, in adolescents who underwent laparoscopic varicocelectomy. Methods: A total of 60 patients with a median age of 16 years, who received laparoscopic varicocele repair, were included in this randomized clinical trial. The patients were randomly assigned to three study groups receiving 2% lidocaine, 0.5% levobupivacaine, or the control group. The Visual Analogue Scale (VAS) was used by a blinded nurse at four different time points (2, 6, 12 and 24 h after the surgery) to measure pain intensity. Results: The significant effect of time on the pain intensity (p = 0.001) was found. Additionally, the interaction between time and different local analgesics (p < 0.001) was observed. In patients in whom 0.5% levobupivacaine has been used, significantly lower VAS pain scores were recorded at each time point assessed, in comparison with the patients who received 2% lidocaine or the patients from the control group in whom no local anesthetic was applied (p < 0.001). Furthermore, in patients in whom 2% lidocaine was administrated, significantly lower pain levels according to VAS were reported than in those from the control group, except for the time point at 24 h after surgery when pain levels were comparable. Concerning the postoperative pain control, the number of patients who requested oral analgesics postoperatively was significantly lower in the group of patients in whom local anesthetic was administrated intraoperatively (2% lidocaine – n = 4, 20%; 0.5% levobupivacaine – n = 1, 5%) compared to the patients who did not receive any local anesthetic during the surgery (n = 13; 65%) (p < 0.001). Conclusion: A significant reduction in postoperative pain intensity and analgesics consumption in patients undergoing laparoscopic varicocelectomy who received intraoperative local anesthetic was observed. The best effect on postoperative pain intensity, according to the VAS score, was achieved by 0.5% levobupivacaine.

Download Full-text