Reduction in Sodium Content of Local Anesthetics for Peripheral Nerve Blocks

The shortage of doctors is a societal problem, especially in rural areas such as Akita Prefecture, Japan. Therefore, it is not unusual in Akita for orthopedic surgeons to perform upper and lower limb surgeries under ultrasound-guided peripheral nerve blocks managed by the operators themselves. Multicenter studies of ultrasound-guided peripheral nerve blocks performed by orthopedic surgeons have not been reported. The purpose of this study was to clarify the safety and reliability of ultrasound-guided peripheral nerve blocks performed by orthopedic surgeons in Akita. A total of 1,674 upper extremity surgery cases operated under ultrasound-guided peripheral nerve blocks at 8 hospitals in Akita prefecture from April 2016 to April 2018 were investigated retrospectively. These blocks were performed by a total of 37 orthopedic surgeons, including senior surgeons and residents. In 321 of the 1,674 cases (19%), local anesthetics were added to the surgical field. Two cases with special factors were converted to general anesthesia. There were 2 cases of complications associated with the nerve block, but they were all transient and recovered promptly. The block site and the hospital where the block was performed showed a significant relationship with the addition of local anesthetics to the surgical site ( P < 0.001 ). Surgery time, age at surgery, and surgical site showed no significant relationships with the addition of local anesthetics. The volume of the anesthetic used for the nerve block showed a significant inverse relationship with the addition of local anesthetics ( P = 0.040 ). Many orthopedic surgeons in Akita prefecture began to perform ultrasound-guided peripheral nerve blocks, which had a reliable anesthesia effect with no noticeable complications, whether performed by residents or senior orthopedic surgeons, and this is a useful anesthetic technique for orthopedic surgeons.

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Review of adjuvants to local anesthetics in peripheral nerve blocks: Current and future trends

Saudi Journal of Anaesthesia ◽

10.4103/sja.sja_423_19 ◽

2020 ◽

Vol 14 (1) ◽

pp. 77 ◽

Cited By ~ 4

Author(s):

GV Krishna Prasad ◽

Sangeeta Khanna ◽

SharmaVipin Jaishree

Keyword(s):

Peripheral Nerve ◽

Local Anesthetics ◽

Future Trends ◽

Nerve Blocks ◽

Peripheral Nerve Blocks

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New peripheral nerve blocks and local anesthetics

Current Opinion in Critical Care ◽

10.1097/mcc.0000000000000873 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Sinem Sari ◽

Jennifer Kumar ◽

Alparslan Turan

Keyword(s):

Peripheral Nerve ◽

Local Anesthetics ◽

Nerve Blocks ◽

Peripheral Nerve Blocks

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Efficacy of Dexmedetomidine as an Adjuvant to Bupivacaine in Peripheral Nerve Block - Three Prospective Randomized Controlled Studies

QJM ◽

10.1093/qjmed/hcaa039.033 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

G M Nassif ◽

B M E Noreldin ◽

H M M Elazzazi ◽

F A Abdelmalek ◽

M M Maarouf

Keyword(s):

Peripheral Nerve ◽

Nerve Block ◽

Local Anesthetics ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Group I ◽

Group Ii ◽

Long Acting

Abstract Introduction Peripheral nerve blocks are frequently used as the sole anesthetic technique or as an adjuvant to general anesthesia, However, the duration of sensory nerve block after single doses of long-acting local anesthetics is not consistent enough to avoid the use of postoperative opioids. Many adjuvants have been added to prolong the duration of nerve block, It was recently suggested that, based on current evidence, perineural dexmedetomidine is the most promising adjuvant to extend the duration of long-acting local anesthetics Aim The aim of this work is to study the effects of dexmedetomidine as an adjuvant to bupivacaine in various peripheral nerve blocks. The study will include: supraclavicular brachial plexus block, paravertebral block and femoral nerve block. Patients Adult patients of either sex aged 25 – 60 years, ASA physical status I and II, Elective surgeries appropriate for the nerve block. Methods patients received bupivacaine 0.5% alone in (group I) or bupivacaine 0.5% combined with 100 dexmedetomidine (group II) in peripheral nerve blocks. Motor and sensory block onset times; durations of blockades and analgesia were recorded Results Sensory and motor block onset times were shorter in group II than in group I. Sensory and motor blockade durations were longer in group II than in group I. Duration of analgesia was longer in group II than in group I. Systolic, diastolic arterial blood pressure levels, and heart rate were less in group II. Conclusion In the current study, it was obvious that:(Addition of dexmedetomidine to bupivacaine in supraclavicular nerve block, paravertebral nerve block and femoral nerve block has shortened the onset times of both sensory and motor blocks and significantly prolonged their durations, Dexmedetomidine had also the added effect of sedation with minimal side effects, which makes it a beneficial adjuvant to local anesthetics in peripheral nerve blocks, Addition of dexmedetomidine to bupivacaine prolonged the postoperative analgesia with subsequent consumption of less amount of analgesics and The use of ultrasonography in performing nerve blocks significantly reduced the incidence of complications such as pneumothorax or intra-arterial injection and hence, lowered the incidence of systemic toxicity of local anesthetics).

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