scholarly journals Anaesthesia and Postoperative Analgesia Performed by Insertion of a Perineural Catheter at the Brachial Plexus Site - Case Series

2015 ◽  
Vol 61 (3) ◽  
pp. 241-244
Author(s):  
Lazar Alexandra ◽  
Szederjesi Janos ◽  
Copotoiu Sanda Maria ◽  
Simon Noemi Szidonia ◽  
Badea Iudita ◽  
...  
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Brachial Plexus ◽  
Postoperative Analgesia ◽  
Postoperative Period ◽  
Case Series ◽  
Postoperative Pain Management ◽  
Perineural Catheter ◽  
Plexus Block ◽  
Systemic Drug

Abstract Postoperative pain management is of major importance and the existence of a device that ensures a good analgesia in the immediate postoperative period and also removes the side effects of the systemic drugs, is becoming a necessity. Objectives: The goal was to obtain a good quality anaesthesia and also a good postoperative analgesia by inserting a perineural catheter at the brachial plexus site. Material and method: This study included adult patients who underwent brachial plexus anaesthesia through a perineural catheter inserted at the brachial plexus site. The perineural catheter was introduced by ultrasound guidance with neurostimulation control. After insertion, a quantity of a an-aesthetic admixture of 0.4mg/kg is administered. The anaesthetic admixture contained Ropivacaine and Lidocaine, equimolar concentration of 0.5% In the postoperative period, the analgesia was ensured trough the already installed catheter. The analgesic mixture contained Ropivacaine and Lidocaine, equivalent concentrations of 0.25%. The administration rate was 5 ml every 4 hours, starting 6 hours postoperatively. Results: The anaesthesia, obtained through the perineural catheter, was a good quality anaesthesia ensuring both, good sensory and motor block. The feedback regarding postoperative analgesia was positive, this type of pain management being efficient and without the systemic drug side effects. This approach of brachial plexus block was accepted easily by the patients and was rated as a very satisfactory method. Conclusions: The insertion of a perineural catheter for anaesthesia and postoperative analgesia represents a safe and efficient method of achieving both analgesia and anaesthesia.

INTERSCALENE BRACHIAL PLEXUS BLOCK WITH A NERVE STIMULATOR FOR CLAVICULAR FRACTURE SURGERY

2014 ◽  
pp. 20-24
Author(s):  
Van Minh Nguyen
Keyword(s):  
Side Effects ◽  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Clavicle Fracture ◽  
Onset Time ◽  
Clavicular Fracture ◽  
Nerve Stimulator ◽  
Interscalene Brachial Plexus Block ◽  
Plexus Block ◽  
Fracture Surgery

Objective:To evaluate the effectiveness and side effects, complications of interscalene brachial plexus block with a nerve stimulator for clavicular fracture surgery. Materials and Methods:In a prospective descriptive study, fifty patients received interscalene brachial plexus block for fixation of clavicle fracture. The dose was 7 mg/kg of 1% lidocaine mixed with 1 : 200000 adrenaline. Results:The success rate was 94%, including 4% of patients needed sedation and small amount of narcotic, failure rate was 6%. The minimal stimulating current of the nerve location was 0.46 ±0.08 mA, the onset time of sensory block was 8.86 ±2.65min. There were 3 complications with one Horner’s syndrome and two hoarsenesses. Conclusion:We found that in patients undergoing fixation of clavicle fracture the interscalene block with a nerve stimulator was an effective anesthetic with a low rate of side effects and complications. Key words:Interscalene block, nerve stimulator, clavicular fracture surgery.

scholarly journals Comparative Study in the Management of Postoperative Pain with High Dose Intravenous Paracetamol versus Tramadol

2021 ◽  
Vol 5 (4) ◽  
pp. 1-6
Author(s):  
Tanudeep Kaur ◽  
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Emotional Experience ◽  
Postoperative Pain Management ◽  
Economic Benefits ◽  
High Dose ◽  
Postoperative Patient ◽  
Intravenous Paracetamol

Pain is an unpleasant sensory and emotional experience causing agony and several side effects in a postoperative patient. Thus effective postoperative pain management has a humanitarian role with additional medical and economic benefits Paracetamol (PCM) has been widely used as an effective analgesic and antipyretic for over a century with an established safety profile, and Tramadol is a commonly used intravenous drug for postoperative pain relief.

scholarly journals A COMPARATIVE STUDY OF ROPIVACAINE VERSUS ROPIVACAINE WITH DEXMEDETOMIDINE AS AN ADJUVANT IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

2021 ◽  
pp. 138-142
Author(s):  
Deba Gopal Pathak ◽  
Dipanjali Nath
Keyword(s):  
Side Effects ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Local Anesthetic ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Sensory Blockade ◽  
Suitable Alternative ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

BACKGROUND : Supraclavicular approach to brachial plexus block is a versatile and reliable regional anesthesia technique and a suitable alternative to general anesthesia for upper limb surgical procedures. Ropivacaine , a long acting local anesthetic, with less tendency for neurotoxicity and cardiotoxicity is a great local anesthetic for the procedure. Use of adjuvant Dexmedetomidine , a potent alpha 2 adrenoreceptor agonist improves the quality of anesthesia as well as intra-operative and post-operative analgesia while maintaining haemodynamic stability, arousable sedation and mild respiratory depression. MATERIALS AND METHODS: Eighty patients aged between 18 and 60 years with ASA grade I or II posted for elective upper limb surgeries were included in the study and were randomly divided into 2 groups with forty patients in each. Group A received 0.5% ropivacaine (31 mL) and Group B received 0.5% ropivacaine + dexmedetomidine 1microgram/kg (31mL). Both groups were compared for onset time and duration of sensory blockade, onset time and duration of motor blockade , total duration of analgesia and associated side effects. CONCLUSION : Dexmedetomidine as an adjuvant to ropivacaine in the supraclavicular brachial plexus block for upper limb surgeries , significantly shortens the onset time and prolongs the duration of sensory and motor blocks, with longer duration of post-operative analgesia , with associated significant sedation and a few manageable side effects like bradycardia and hypotension.

Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery

2019 ◽  
Vol 131 (6) ◽  
pp. 1316-1326 ◽  
Author(s):  
RyungA Kang ◽  
Ji Seon Jeong ◽  
Ki Jinn Chin ◽  
Jae Chul Yoo ◽  
Jong Hwan Lee ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Postoperative Analgesia ◽  
Brachial Plexus Block ◽  
Group Versus ◽  
Shoulder Surgery ◽  
Interscalene Block ◽  
Block Group ◽  
Interscalene Brachial Plexus Block ◽  
Arthroscopic Shoulder Surgery ◽  
Plexus Block

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Interscalene brachial plexus block of the C5–C6 roots provides highly effective postoperative analgesia after shoulder surgery but usually results in hemidiaphragmatic paresis. Injection around the superior trunk of the brachial plexus is an alternative technique that may reduce this risk. The authors hypothesized that the superior trunk block would provide noninferior postoperative analgesia compared with the interscalene block and reduce hemidiaphragmatic paresis. Methods Eighty patients undergoing arthroscopic shoulder surgery were randomized to receive a preoperative injection of 15 ml of 0.5% ropivacaine and 5 μg · ml−1 epinephrine around either (1) the C5–C6 nerve roots (interscalene block group) or (2) the superior trunk (superior trunk block group). The primary outcome was pain intensity 24 h after surgery measured on an 11-point numerical rating score; the prespecified noninferiority limit was 1. Diaphragmatic function was assessed using both ultrasonographic measurement of excursion and incentive spirometry by a blinded investigator before and 30 min after block completion. Results Seventy-eight patients completed the study. The pain score 24 h postoperatively (means ± SDs) was 1.4 ± 1.0 versus 1.2 ± 1.0 in the superior trunk block (n = 38) and interscalene block (n = 40) groups, respectively. The mean difference in pain scores was 0.1 (95% CI, −0.3 to 0.6), and the upper limit of the 95% CI was lower than the prespecified noninferiority limit. Analgesic requirements and all other pain measurements were similar between groups. Hemidiaphragmatic paresis was observed in 97.5% of the interscalene block group versus 76.3% of the superior trunk block group (P = 0.006); paresis was complete in 72.5% versus 5.3% of the patients, respectively. The decrease in spirometry values from baseline was significantly greater in the interscalene block group. Conclusions The superior trunk block provided noninferior analgesia compared with interscalene brachial plexus block for up to 24 h after arthroscopic shoulder surgery and resulted in significantly less hemidiaphragmatic paresis.

scholarly journals Continuous Fentanyl Background Infusion Regimen Optimised by Patient-Controlled Analgesia for Acute Postoperative Pain Management: A Randomised Controlled Trial

2020 ◽  
Vol 9 (1) ◽  
pp. 211 ◽  
Author(s):  
Jihoon Hwang ◽  
Sang Kee Min ◽  
Yun Jeong Chae ◽  
Gang Mee Lim ◽  
Han Bum Joe
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Postoperative Pain Management ◽  
Patient Controlled Analgesia ◽  
Acute Postoperative Pain ◽  
Background Infusion ◽  
Randomised Controlled

Owing to a lack of studies investigating the effect of adjustments in fentanyl background infusion (BI) with patient-controlled analgesia (PCA) on postoperative analgesia, we evaluated three BI regimens with fentanyl PCA for acute postoperative pain management. This randomised controlled trial enrolled 105 patients, who were assigned to three parallel groups: constant rate BI of 2 mL/h (CRBI group); time-scheduled decremental BI of 6, 2 and 1 mL/h (TDBI group); and BI rates optimised to the demand of PCA (POBI group). The incidence of insufficient analgesia, visual analogue scale (VAS) pain score and side effects were evaluated. The incidence of insufficient analgesia in the post-anaesthesia care unit was lower in the TDBI and POBI groups than the CRBI group. Incidence of insufficient analgesia in the ward was lower in the POBI group than the CRBI group. Postoperative VAS scores were significantly lower in the TDBI and POBI groups for up to 4 h and 24 h, respectively, compared with the CRBI group. Side effects and infused fentanyl dose were highest in the CRBI group. Adjusting BI rate based on time or patient demands could improve postoperative analgesia and reduce side effects. Compared to a constant BI rate, PCA-optimised BI achieved higher patient satisfaction.

scholarly journals Safety and Tolerability of Lidocaine Infusions as a Component of Multimodal Postoperative Analgesia in Children

2019 ◽  
Vol 24 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Katherine Lemming ◽  
Gary Fang ◽  
Marcia L. Buck
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Adverse Effects ◽  
Dose Reduction ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Postoperative Pain Management ◽  
Nuss Procedure ◽  
The Mean

OBJECTIVES Use of lidocaine as part of a multimodal approach to postoperative pain management has increased in adults; however, limited information is available regarding safety and tolerability in pediatrics. This study's primary objective was to evaluate the incidence of adverse effects related to lidocaine infusions in a sample of pediatric patients. METHODS A retrospective analysis was conducted in pediatric patients receiving lidocaine infusion for the management of postoperative analgesia at the University of Virginia Health System. RESULTS A total of 50 patients with 51 infusions were included in the final analysis. The median patient age was 14 years (range, 2–17 years). The most frequent surgeries were spinal fusion (30%), Nuss procedure for pectus excavatum (16%), and nephrectomy (6%). The mean ± SD starting rate was 13.6 ± 6.5 mcg/kg/min. The mean infusion rate during administration was 15.2 ± 6.3 mcg/kg/min, with 14.4 ± 6.2 mcg/kg/min at discontinuation. The mean length of therapy was 30.6 ± 22 hours. A total of 12 infusions (24%) were associated with adverse effects, primarily neurologic ones, including paresthesias in the upper extremities (10%) and visual disturbances (4%). The average time to onset was 16.2 ± 15.2 hours. Seven infusions were discontinued, whereas the remaining infusions resulted in either dose reduction or continuation without further incident. No patients experienced toxicity requiring treatment with lipid emulsion. CONCLUSIONS In this sample, lidocaine was a well-tolerated addition to multimodal postoperative pain management in the pediatric population. Although adverse effects were common, they were mild and resolved with either dose reduction or discontinuation.

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