scholarly journals Dexmedetomidine-induced hemodynamic instability in patients undergoing orthopedic upper limb surgery under brachial plexus block: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
A Ram Doo ◽  
Hyungseok Lee ◽  
Seon Ju Baek ◽  
Jeongwoo Lee
Keyword(s):  
Brachial Plexus ◽  
Regional Anesthesia ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Hemodynamic Instability ◽  
Overweight And Obesity ◽  
Anesthesia Practice ◽  
Female Sex ◽  
Upper Limb Surgery ◽  
Plexus Block

Abstract Background Hemodynamic instability is a frequent adverse effect following administration of dexmedetomidine (DMED). In this study, we evaluated the incidence of DMED-induced hemodynamic instability and its predictive factors in clinical regional anesthesia practice. Methods One hundred sixteen patients who underwent orthopedic upper limb surgery under brachial plexus block with intravenous DMED administration were retrospectively identified. The primary outcome was the incidence of DMED-induced hemodynamic instability. The participants were allocated to a stable or unstable group by their hemodynamic instability status. Patients’ characteristics were compared between the groups. The relationship between the potential risk factors and development of DMED-induced hemodynamic instability was analyzed with a logistic regression model. Results DMED-induced hemodynamic instability was observed in 14.7% of patients (17/116). The unstable group had more women than the stable group (76.5% vs. 39.4%, P = 0.010). When patients were classified into four subgroup according to body mass index (underweight, normal weight, overweight, and obesity), there was significant difference in the composition of the subgroups in the two groups (P = 0.008). In univariate analysis, female sex, obesity, and pre-existing hypertension were significant predictors of DMED-induced hemodynamic instability. Multivariate analysis demonstrated that female sex (adjusted OR 3.86, CI 1.09; 13.59, P = 0.036) and obesity (adjusted OR 6.41, CI 1.22; 33.57, P = 0.028) were independent predictors of DMED-induced hemodynamic instability. Conclusions Female and obese patients are more likely to have hemodynamic instability following intravenous DMED administration in clinical regional anesthesia practice. This study suggests that DMED dose may be diminished to prevent hypotensive risk in these populations. Trial registration This article was retrospectively registered at WHO clinical trial registry platform (Trial number: KCT0005977).

scholarly journals Efficacy and safety of ultrasound-guided brachial plexus blocks for upper limb surgery

2015 ◽  
Vol 10 (2) ◽  
pp. 164-171
Author(s):  
Raluca UNGUREANU ◽  
◽  
Liliana MIREA ◽  
Ioana GRINŢESCU ◽  
Dan TULBURE ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Local Anesthetic ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Ultrasound Guided ◽  
Block Success ◽  
Upper Limb Surgery ◽  
Locoregional Anesthesia ◽  
Plexus Block

Introduction. The use of ultrasound (US) for brachial plexus block has increased enthusiasm because the anesthesiologist can visualize anatomy, needle placement, and local anesthetic spread during locoregional anesthesia. The objectives of this prospective study was to evaluate the efficacy and the safety of ultrasound guided brachial plexus block comparative with traditional method of neurostimulation. Material and methods. In this randomized controlled clinical trial we included patients over 18 years old with upper limb surgery and who benefit of brachial plexus block (axillary, interscalenic or combined blocks). After monitoring and sedation, the patients randomly received ultrasound-guided (62 pts.) or neuro stimulation (63 pts.) brachial plexus block with ropivacaine 0.5%. We recorded data about: block success rate, sensitive and motor block onset time, block performance time, immediate and late complications events, patient’s satisfaction rate. The results were statistically analyzed, with significance assumed at p<0.05. Results. Block success rate with ultrasound guidance was very high (93.5% in US group and 84% in NS group). The patients of US group received less volume of local anesthetic (20.89 ± 3.9 ml vs. 43 ± 5.1 ml in NS group, p < 0.05). The performance time, needle punctures, sensory and motor onset time was significant reduced in US group. In the NS group we recorded 2 local anesthetic systemic toxicity (minor-moderate neurologic symptoms) with complete recovery and none in US group. We recorded less paresthesia during block performance and vascular puncture due to US guidance (p<0.05). Patient acceptance with locoregional anesthesia is good, even patients experience more discomfort during neurostimulation technique. Conclusions. The results of this study suggest that both techniques of execution of brachial plexus block are adequate for upper limb surgery but US guidance provides significant benefits for patients in terms of efficacy and safety.

Brachial Plexus Anaesthesia for Upper Limb Surgery: A Review of Eight Years’ Experience

1988 ◽  
Vol 13 (2) ◽  
pp. 195-198
Author(s):  
A. M. THOMPSON ◽  
R. J. NEWMAN ◽  
J. C. SEMPLE
Keyword(s):  
Brachial Plexus ◽  
Success Rate ◽  
General Anaesthesia ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Success Rates ◽  
Upper Limb Surgery ◽  
Plexus Block

1248 supraclavicular brachial plexus blocks and 665 axillary plexus blocks were administered to 1913 patients undergoing upper limb surgery. Plexus block alone was successful in 83.5%. In a further 11.4% of cases, adequate anaesthesia was obtained following augmentation by other regional or local techniques. This resulted in an overall success rate of 94.9% and general anaesthesia was required in only 5.1%. The two percutaneous approaches to the brachial plexus did not differ in their success-rates but clinically apparent pneumothorax occurred in 0.8% of supraclavicular blocks. Brachial plexus block anaesthesia is recommended as a safe and satisfactory alternative to general anaesthesia for upper limb surgery.

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