scholarly journals Functional Recovery of Rare Case of Sciatic Nerve Schwannoma with Peripheral Nerve Block and without Intraoperative Neurophysiological Monitoring

2020 ◽  
Vol 52 (2) ◽  
pp. 119-124
Author(s):  
Jefri Henky ◽  
Ahmad Faried
Keyword(s):  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Functional Recovery ◽  
Rare Case ◽  
Peripheral Nerve Block ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring

scholarly journals Functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery: a systematic review protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Jennifer Héroux ◽  
Emilie Belley-Côté ◽  
Pablo Echavé ◽  
Marie-Josée Loignon ◽  
Pierre-Olivier Bessette ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peripheral Nerve ◽  
General Anesthesia ◽  
Nerve Block ◽  
Upper Limb ◽  
Functional Recovery ◽  
Peripheral Nerve Block ◽  
Upper Limb Surgery ◽  
Grade Methodology ◽  
The Impact

Abstract Background Peripheral nerve block is a single injection that inhibits the transmission of peripheral nerve impulses to the central nervous system. The inhibition of the nociceptive impulse may decrease the occurrence of muscle spasm following mobilization postoperatively. This mechanism may contribute to a better functional recovery following upper limb surgery. This systematic review will investigate the impact of peripheral nerve block on functional recovery after an upper limb surgery. Methods We will search studies comparing peripheral nerve block to general anesthesia for upper limb surgery in the following databases: CENTRAL, MEDLINE (Ovid), CINAHL, EMBASE, and Scopus. In duplicate, independent reviewers will assess eligibility, evaluate risk of bias, and abstract data on type of peripheral nerve block and functional outcome. Where possible, we will pool results using a random effects model. For each outcome, we will assess the quality of evidence using GRADE methodology. Discussion We aim to summarize the available evidence comparing functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery. These data will inform the design of a trial on the topic. Systematic review registration PROSPERO CRD42018116298

scholarly journals Combined femoral and sciatic nerve block with Levobupivacaine in Brugada syndrome patient: A case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Diego Tavoletti ◽  
Elisabetta Rosanò ◽  
Elisabetta Cerutti ◽  
Luca Pecora
Keyword(s):  
Case Report ◽  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Brugada Syndrome ◽  
Peripheral Nerve Block ◽  
Case Reports ◽  
Anesthetic Techniques ◽  
Syndrome Patient

Introduction: Brugada syndrome is a rare arrhythmic disorder associated to ventricular fibrillation and sudden cardiac death. General recommendations in Brugada syndrome patient are focused on avoiding increases in vagal tone and precipitating agents such as electrolyte disorders, hypo/hyperthermia and drugs. Anesthetic management in Brugada syndrome patient has been described in many case reports, however it is still unknown which anesthesia is the safest. Local anesthetic may have a theoretical arrhythmogenic risk, but currently there is no clear evidence and their risk is still debated. Peripheral nerve block avoids autonomic nervous system changes that occur with other anesthetic techniques and it is associated to a lower level in the plasma concentration of the local anesthetic compared with neuraxial anesthesia. Case Report: We report a case of a 38-year-old man patient with Brugada syndrome who underwent urgent orthopedic surgery which was managed with a combined femoral and sciatic nerve blocks using levobupivacaine without any complications. Conclusions: Peripheral nerve block with levobupivacaine provided good analgesia, hemodynamic and cardiac stability in Brugada syndrome patient. Keywords: Brugada syndrome, Anesthesia, Levobupivacaine, Peripheral nerve block, Regional anesthesia

On the Mechanism by Which Epinephrine Potentiates Lidocaine's Peripheral Nerve Block

2003 ◽  
Vol 98 (1) ◽  
pp. 181-188 ◽  
Author(s):  
Catherine J. Sinnott ◽  
Lawrence P. Cogswell ◽  
Anthony Johnson ◽  
Gary R. Strichartz
Keyword(s):  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Behavioral Observation ◽  
Nerve Blocks ◽  
Pharmacodynamic Effects ◽  
Early Increase ◽  
Prolonged Duration ◽  
Kinetics Of

Background Adding epinephrine to lidocaine solutions for peripheral nerve block potentiates and prolongs the action, but by incompletely understood mechanisms. In an effort to discriminate the pharmacokinetic from the pharmacodynamic effects of epinephrine, the authors measured the lidocaine content of peripheral nerve over the course of block produced by 0.5% lidocaine, with and without epinephrine, and correlated it with the degree of analgesia. Methods Percutaneous sciatic nerve blocks were performed in 18 groups of rats (10 in each) with 0.1 ml of either 0.5% lidocaine or 0.5% lidocaine with epinephrine (1:100,000). Over the full course of nerve block, the authors regularly measured analgesia to toe pinch and then rapidly removed nerves to assay intraneural lidocaine content at 2-120 min after injection. Results The kinetics of lidocaine's clearance from nerve was composed of a fast-decaying transient superimposed on a very slowly decaying component. The effect of epinephrine on the intraneural lidocaine content was to increase the amount of lidocaine in the slow-decaying component by threefold to fourfold, although the total neural content was not altered by epinephrine for the first 10 min after injection. Epinephrine prolonged blockade by almost fourfold and enhanced the intensity of peak analgesia, as well as the fraction of rats with complete block, almost throughout the 2-120-min period of behavioral observation. Conclusions Adding epinephrine to lidocaine solutions increases the intensity and duration of sciatic nerve block in the rat. The early increase in intensity is not matched with an increase in intraneural lidocaine content at these early times, although the prolonged duration of block by epinephrine appears to correspond to an enlarged lidocaine content in nerve at later times, as if a very slowly emptying "effector compartment" received a larger share of the dose. The increase in early analgesia without increased lidocaine content may be explained by a pharmacodynamic action of epinephrine that transiently enhances lidocaine's potency, but also by a pharmacokinetic effect that alters the distribution of the same net content of lidocaine within the nerve.

scholarly journals Anaesthetic Management of a Patient with Thyrotoxicosis for Nonthyroid Surgery with Peripheral Nerve Blockade

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Mehmet I. Buget ◽  
Bilge Sencan ◽  
Giray Varansu ◽  
Suleyman Kucukay
Keyword(s):  
Thyroid Hormone ◽  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Anaesthetic Management ◽  
Sympathetic Stimulation ◽  
Neuraxial Block ◽  
Peripheral Nerve Blockade ◽  
Thyroid Hormone Levels

Thyrotoxicosis is a hypermetabolic condition caused by an elevation in thyroid hormone levels. The disorder has a variety of causes, manifestations, and therapies. Several clinical features of thyrotoxicosis are due to sympathetic stimulation with increased beta-adrenoreceptor upregulation and sensitization to catecholamine. Anaesthetic management of thyrotoxicosis patients using neuraxial block has been described in literature; however, to our knowledge, there are no reports of peripheral nerve block utilization. Here, we report on the anaesthetic management of a patient with thyroiditis-associated thyrotoxicosis undergoing emergency surgery via a femoral and sciatic nerve block.

Relation between Functional Deficit and Intraneural Local Anesthetic during Peripheral Nerve Block

1995 ◽  
Vol 83 (3) ◽  
pp. 583-592. ◽  
Author(s):  
F. A. Popitz-Bergez ◽  
S. Leeson ◽  
G. R. Strichartz ◽  
J. G. Thalhammer
Keyword(s):  
Steady State ◽  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Peripheral Nerve Block ◽  
Longitudinal Distribution ◽  
Functional Block

Background During peripheral nerve block, local anesthetic (LA) penetrates within and along the nerve to produce the observed functional deficits. Although much is known about the kinetics and steady-state relation for LA inhibition of impulse activity in vitro in isolated nerve, little is known about the relation between functional loss and intraneural LA content in vivo. This study was undertaken to investigate the relation of functional change to intraneural LA. Methods A sciatic nerve block was performed in rats with 0.1 ml 1% lidocaine radiolabeled with 14C. The total intraneural uptake of LA was determined at different times after injection, and the distribution of lidocaine along the nerve was assayed at different stages of functional block. Drug content was also compared with equilibrium lidocaine uptake in the isolated rat sciatic nerve. Results Total intraneural lidocaine in vivo increased to near steady-state in about 3 min, stabilizing at approximately 14.3 nmol/mg wet tissue for about 12 min before decreasing to zero at 70 min after injection. Although intraneural lidocaine was 1.6% of the injected dose during full block, only 0.3% was left when deep pain sensation returned and 0.065% was still detected when functions fully recovered. Despite these large differences in total lidocaine content, the longitudinal distribution remained constant. Intraneural lidocaine concentrations obtained at full block and partial recovery could be achieved in vitro by equilibration in 0.7-0.9 and 0.2-0.3 mM lidocaine, respectively. Conclusions During peripheral nerve block only a small amount of injected LA penetrates into the nerve. The intraneural content of LA correlates with the depth of functional block.

scholarly journals Factors associated with low levels of patient satisfaction following peripheral nerve block

2021 ◽  
pp. 0310057X2097240
Author(s):  
Anthony D Hade ◽  
Satomi Okano ◽  
Anita Pelecanos ◽  
Adrian Chin
Keyword(s):  
Patient Satisfaction ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Moderate Intensity ◽  
Post Anaesthesia Care Unit ◽  
Negatively Associated ◽  
Factors Associated ◽  
Low Levels ◽  
Anaesthesia Care

Peripheral nerve blocks can provide surgical anaesthesia as well as excellent postoperative analgesia. When questioned postoperatively, however, some patients report low levels of satisfaction with their nerve block experience. At our hospital, patients undergoing regional anaesthesia have their patient characteristics, block characteristics and postoperative feedback routinely recorded in a block registry. We analysed data from 979 consecutive patients undergoing peripheral nerve block for orthopaedic surgery to identify factors associated with low levels of patient satisfaction. The primary outcome was patient satisfaction with their peripheral nerve block (scale 1–5: 4–5 is ‘satisfied’, 1–3 is ‘not satisfied’). Eighty-nine percent (871/979) of patients reported being ‘satisfied’ with their block. Factors negatively associated with patient satisfaction were rebound pain (adjusted odds ratio (aOR) 0.19, 95% confidence interval (CI) 0.04 to 0.85 for moderate rebound pain; aOR 0.11, 95% CI 0.03 to 0.48 for severe rebound pain), discomfort during the block (aOR 0.37, 95% CI 0.16 to 0.82 for moderate discomfort; aOR 0.19, 95% CI 0.05 to 0.76 for severe discomfort) and pain in the post-anaesthesia care unit (aOR 0.30, 95% CI 0.17 to 0.55 for pain ≥8/10). Only 24% (26/108) of patients who reported being ‘not satisfied’ stated that they would be unwilling to undergo a hypothetical future nerve block. Rebound pain of at least moderate intensity, procedural discomfort of at least moderate intensity and severe pain in the post-anaesthesia care unit are all negatively associated with patient satisfaction. Of these factors, rebound pain occurs most frequently, being present in 52% (403/777) of our respondents.

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