scholarly journals Approaching trauma analgesia using prolonged and novel continuous peripheral nerve blocks - A case report -

2021 ◽  
Author(s):  
Eric Ly ◽  
Sai Velamuri ◽  
William Hickerson ◽  
David M. Hill ◽  
Jay Desai ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Quadriceps Strength ◽  
Complex Case ◽  
Opioid Use ◽  
Nerve Blocks ◽  
Degloving Injury ◽  
Continuous Peripheral Nerve Block ◽  
Chronic Opioid Use

Background A supraclavicular brachial plexus nerve block provides analgesia for the shoulder, arm, and hand; however, the maximum safe duration for a continuous infusion remains controversial. A novel continuous peripheral nerve block (CPNB) technique combining the Lateral, Intermediate, and Medial femoral cutaneous nerves (termed the ‘LIM’ block) to provide analgesia to the lateral, anterior, and medial cutaneous areas of the thigh while preserving quadriceps strength will also be described in detail here. CaseWe present a complex case in which simultaneous utilization of an unilateral supraclavicular CPNB (5 weeks) and bilateral LIM CPNB (5 days) are successfully performed to provide analgesia for a traumatic degloving injury resulting in multiple surgeries.Conclusions The analgesic plan in this case study eliminated previous episodes of opioid-induced delirium, facilitated participation in recovery, and removed concerns for respiratory depression and chronic opioid use in a patient at particular risk for both issues.

The Effects of Perioperative Peripheral Nerve Blocks on Peri- and Postoperative Opioid Use and Pain Management

2021 ◽  
pp. 000313482110233
Author(s):  
Taylor W. Cardwell ◽  
Vanessa Zabala ◽  
Jocelyn Mineo ◽  
Christopher N. Ochner
Keyword(s):  
Pain Management ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Pain Scores ◽  
Patient Reported ◽  
Postoperative Physical Therapy

Introduction The amount of peri- and post-operative use of opioids for pain management, and the duration in which they are used following surgery, are positively associated with the likelihood of subsequent opioid use and addiction. Aware of this issue, many clinicians are seeking ways to reduce opioid use while maintaining adequate pain management. Recent evidence suggests that peripheral nerve block utilization may present a viable mechanism by which clinicians can accomplish this goal. Methods Ovid MEDLINE and Pubmed databases were searched to identify relevant articles. Using the advanced search option, the key terms “opioid,” “morphine,” “nerve block,” “peripheral anesthesia,” “pain management,” “preoperative,”, “intraoperative,” and “postoperative” were used and combined with the Boolean terms “AND” and “OR.” This review examines the extant literature surrounding the use of peripheral nerve blocks in relation to patient-reported pain scores, intraoperative opioids, postoperative opioids, patient-controlled analgesic with opioids, and opioid consumption once the patient has left the hospital. Further, the effect peripheral nerve blocks have on postoperative physical therapy, surgery related complications, and overall patient satisfaction are briefly discussed. Results The use of perioperative peripheral nerve blocks decreases opioid consumption not only in the postoperative period, but also intraoperatively as well. The most significant decrease in opioid consumption is seen in the first 24-72 hours postoperatively. Patient reported pain scores were also lower in patients who received peripheral nerve blocks. Discussion Despite relatively robust efficacy data, utilization of peripheral nerve blocks is not ubiquitous; the potential reasons for which are also discussed. Lastly, clinical recommendations based on the available data are provided.

scholarly journals Prolonged Use of a Continuous Peripheral Nerve Block Catheter for Analgesia after Pediatric Foot and Ankle Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Jake MacDonald ◽  
De-An Zhang
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Effective Means ◽  
Metatarsal Osteotomy ◽  
Opioid Use ◽  
Nerve Blocks ◽  
First Metatarsal ◽  
Pediatric Foot ◽  
One Year

Continuous peripheral nerve blocks (CPNB) have a variety of indications and have been shown to be a safe and effective means of minimizing pain postoperatively. Early studies have indicated duration of catheter use greater than 48 hours as a main contributor to infection risk in CPNBs. Recent studies, though, have suggested that the risk of infection does not increase until 4 days after insertion. In the following case report, we recount our experience in using a continuous popliteal-sciatic peripheral nerve block for postoperative pain control in a pediatric patient following calcaneal and first metatarsal osteotomy. The catheter remained in place for 65 hours postoperatively without signs of local inflammation or infection. The prolonged CPNB use resulted in a significant decrease in postoperative opioid use and pain and increase in patient satisfaction when compared to the same procedure done one year prior on the opposite foot.

Incidence and characteristics of major adverse events in continuous peripheral nerve block analgesia

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Gabriela Klingler ◽  
Martina Senn ◽  
Paul Imboden ◽  
Christoph A. Rüst ◽  
Thomas W. Schnider ◽  
...  
Keyword(s):  
Adverse Events ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Continuous Peripheral Nerve Block ◽  
Major Adverse Events

Time Sequence of Sensory Changes after Upper Extremity Block

2004 ◽  
Vol 101 (1) ◽  
pp. 162-168 ◽  
Author(s):  
Xavier Paqueron ◽  
Marc E. Gentili ◽  
Jean Claude Willer ◽  
Pierre Coriat ◽  
Bruno Riou
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Clinical Test ◽  
Sensory Impairment ◽  
Sensory Testing ◽  
Early Assessment ◽  
Sensory Assessment ◽  
Nerve Blocks ◽  
Sensory Fibers

Background Sensory assessment to estimate spread and effectiveness of a peripheral nerve block is difficult because no clinical test is specific for small sensory fibers. Occurrence of a swelling illusion (SI) during a peripheral nerve block corresponds to the impairment of small sensory fibers. The authors investigated the usefulness of SI in predicting successful peripheral nerve block by assessing the temporospatial correlation between progression of sensory impairment in cutaneous distributions anesthetized and localization of SI during peripheral nerve block installation. Methods Interscalene, infracoracoid, or sciatic nerve blocks were performed using a nerve stimulator and 1.5% mepivacaine in 53 patients, with a total of 201 nerves to be anesthetized. Pinprick, cold, warm, touch, and proprioception were assessed every 3 min, while patients were asked to describe their perception of size and shape of their anesthetized limb and localization of these illusions. Data are presented as mean +/- SD and percentage (95% confidence interval). Results Failure occurred in 12 cutaneous distributions out of a total of 201 theoretically blocked nerves. SI appeared earlier than warmth impairment (4.3 +/- 2.7 vs. 6.2 +/- 2.0 min; P < 0.05), always corresponding to successfully anesthetized cutaneous distributions, with the exception of 1 patient, who developed SI in 2 cutaneous distributions while sensory testing indicated failure in 1 distribution. SI successfully predicted the blockade of a cutaneous distribution with a sensitivity of 1.00 (0.98-1.00), a specificity of 0.92 (0.65-0.99), and an accuracy of 0.99 (0.97-1.00). Conclusions Swelling illusion may provide an early assessment of the success of a peripheral nerve block in unsedated patients.

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