scholarly journals Effectiveness of additional thoracic paravertebral block in improving anesthetic effects of regional anesthesia for proximal humeral fracture surgery in elderly patients: study protocol for a randomized controlled trial

2020 ◽  
Author(s):  
xiaofeng wang ◽  
Hui Zhang ◽  
Zhenwei Xie ◽  
Qingfu Zhang ◽  
Wei Jiang ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Brachial Plexus ◽  
Regional Anesthesia ◽  
Proximal Humeral Fracture ◽  
Humeral Fracture ◽  
Cervical Plexus ◽  
Thoracic Paravertebral Block ◽  
Cervical Plexus Block ◽  
Plexus Block ◽  
Fracture Surgery

Abstract Background: The innervation of shoulder-upper extremity area is complicated and unclear. Regional anesthesia with brachial plexus and cervical plexus block is probably inadequate for the proximal humeral surgery. Missing blockade of T1-T2 nerves may be the reason. We conduct this prospective randomized controlled trial (RCT) to explore whether additional T2 thoracic paravertebral block (TPVB) can improve the success rate of regional anesthesia for elderly patients in proximal humeral fracture surgery. Methods: The patients aged 65 or older, referred for anterior approach proximal humeral fracture surgery, will be enrolled. Each patient will be randomly assigned 1:1 to receive IC block (combined interscalene brachial plexus with superficial cervical plexus block) or ICTP block (combined thoracic paravertebral block with brachial plexus and superficial cervical plexus block). The primary outcome is the success rate of regional anesthesia without rescue analgesic methods. The secondary outcomes are as follows: sensory block at surgical area, proportion of patients who need rescue anesthesia (intravenous remifentanil or conversion to general anesthesia), cumulative doses of intraoperative vasoactive medications and adverse events. The total sample size is estimated to be 80 patients. Discussion: This RCT aims to confirm whether additional T2 TPVB can provide better anesthetic effects of regional anesthesia with brachial and cervical plexus block in elderly patients undergoing proximal humeral surgery.

scholarly journals Effectiveness of additional thoracic paravertebral block in improving anesthetic effects of regional anesthesia for proximal humeral fracture surgery in elderly patients: study protocol for a randomized controlled trial

2019 ◽  
Author(s):  
Xiaofeng Wang ◽  
Hui Zhang ◽  
Zhenwei Xie ◽  
Qingfu Zhang ◽  
Wei Jiang ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Regional Anesthesia ◽  
Proximal Humeral Fracture ◽  
Humeral Fracture ◽  
Paravertebral Block ◽  
Cervical Plexus ◽  
Thoracic Paravertebral Block ◽  
Cervical Plexus Block ◽  
Plexus Block ◽  
Fracture Surgery

Abstract Background The innervation of shoulder-upper arm area is complicated and unclear. Ultrasound-guided brachial plexus combined with cervical plexus block is probably inadequate for the anesthesia of proximal humeral surgery. Missing blockade of T1-T2 nerves may be the reason. The primary aim of this trial is to investigate the effectiveness of additional T2 thoracic paravertebral block (TPVB) in improving the anesthetic effects of regional anesthesia for elderly patients in proximal humeral fracture surgery. Methods We have designed a two-armed, parallel, randomized controlled trial (RCT) to compare the anesthetic effects of ultrasound-guided brachial and cervical plexus block with or without additional T2 TPVB in terms of the following outcomes: success rate, sensory block and safety. The elderly patients over 65 years old, referred for anterior approach proximal humeral fracture surgery, will be enrolled. Each participant will be randomly assigned 1:1 to receive IC block (combined interscalene brachial plexus with superficial cervical plexus block) or ICTP block (combined thoracic paravertebral block with IC block). The primary outcome is the success rate of surgical anesthesia. The secondary outcomes are as follows: sensory block at surgical area, proportion of participants who need supplementary anesthesia (remifentanil or conversion to general anesthesia), cumulative doses of intraoperative vasoactive medications and adverse events. The necessary sample size is estimated to be 80 patients according to the data of our pilot study. Discussion This RCT aims to demonstrate that whether combined T2 TPVB with brachial and cervical plexus block can provide better anesthetic effects of regional anesthesia in elderly patients undergoing proximal humeral fracture surgery.

scholarly journals Ultrasound-Guided Combined Interscalene-Cervical Plexus Block for Surgical Anesthesia in Clavicular Fractures: A Retrospective Observational Study

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Onur Balaban ◽  
Turan Cihan Dülgeroğlu ◽  
Tayfun Aydın
Keyword(s):  
General Anesthesia ◽  
Regional Anesthesia ◽  
Fracture Repair ◽  
Complication Rates ◽  
Clavicular Fracture ◽  
Ultrasound Guided ◽  
Cervical Plexus ◽  
Cervical Plexus Block ◽  
Plexus Block ◽  
Fracture Surgery

Objective. We aim to report our experiences regarding the implementation of the ultrasound-guided combined interscalene-cervical plexus block (CISCB) technique as a sole anesthesia method in clavicular fracture repair surgery. Materials and Methods. Charts of patients, who underwent clavicular fracture surgery through this technique, were reviewed retrospectively. We used an in-plane ultrasound-guided single-insertion, double-injection combined interscalene-cervical plexus block technique. During the performance of each block, the block areas were visualized by using a linear transducer, and the needles were advanced by using the in-plane technique. Block success and complication rates were evaluated. Results and Discussion. 12 patients underwent clavicular fracture surgery. Surgical regional anesthesia was achieved in 100% of blocks. None of the patients necessitated conversion to general anesthesia during surgery. There were no occurrences of acute complications. Conclusions. The ultrasound-guided combined interscalene-cervical plexus block was a successful and effective regional anesthesia method in clavicular fracture repair. Prospective comparative studies would report the superiority of the regional technique over general anesthesia.

scholarly journals Sedation and Regional Anesthesia for Deep Brain Stimulation in Parkinson’s Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Onur Ozlu ◽  
Sema Sanalbas ◽  
Dilek Yazicioglu ◽  
Gulten Utebey ◽  
Ilkay Baran
Keyword(s):  
Deep Brain Stimulation ◽  
Regional Anesthesia ◽  
Brain Stimulation ◽  
Conscious Sedation ◽  
Cervical Plexus ◽  
Superficial Cervical Plexus Block ◽  
Cervical Plexus Block ◽  
Scalp Block ◽  
Plexus Block ◽  
Deep Brain

Objective. To present the conscious sedation and the regional anesthesia technique, consisting of scalp block and superficial cervical plexus block, used in our institution for patients undergoing deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD). Methods. The study included 26 consecutive patients. A standardized anesthesia protocol was used and clinical data were collected prospectively. Results. Conscious sedation and regional anesthesia were used in all cases. The dexmedetomidine loading dose was 1 μg kg−1 and mean infusion rate was 0.26 μg kg−1 h−1 (0.21) [mean total dexmedetomidine dose: 154.68 μg (64.65)]. Propofol was used to facilitate regional anesthesia. Mean propofol dose was 1.68 mg kg (0.84) [mean total propofol dose: 117.72 mg (59.11)]. Scalp block and superficial cervical plexus block were used for regional anesthesia. Anesthesia related complications were minor. Postoperative pain was evaluated; mean visual analog scale pain scores were 0 at the postoperative 1st and 6th hours and 4 at the 12th and 24th hours. Values are mean (standard deviation). Conclusions. Dexmedetomidine sedation along with scalp block and SCPB provides good surgical conditions and pain relief and does not interfere with neurophysiologic testing during DBS for PD. During DBS the SCPB may be beneficial for patients with osteoarthritic cervical pain. This trial is registered with Clinical Trials Identifier NCT01789385.

scholarly journals Comparison of Ultrasound Guided Interscalene and Supraclavicular Brachial Plexus Block for Clavicle Fracture Surgery

2018 ◽  
Vol 14 (4) ◽  
pp. 189-195
Author(s):  
Lalit Kumar Rajbanshi ◽  
Batsalya Arjyal ◽  
Akriti Bajracharya ◽  
Kanak Khanal
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Clavicle Fracture ◽  
Care Hospital ◽  
Cervical Plexus ◽  
Supraclavicular Approach ◽  
Supraclavicular Brachial Plexus Block ◽  
Cervical Plexus Block ◽  
Plexus Block

Introduction:The clavicle has dual nerve supply from the brachial plexus and cervical plexus. The interscalene brachial plexus block combined with superior cervical plexus block is frequently used for the clavicle surgery. This study was conducted to compare ineterscalene approach with the supraclavicular approach for brachial plexus block used for clavicle surgery Methodology:This was prospective comparative study conducted for two years in tertiary care hospital. Sixty patients with clavicle fracture with ASA I and II were randomly divided into two equal groups; ISBPB (interscalene approach) and SCBPB (supraclavicular approach). Both of these blocks were combined with superior cervical plexus block.  Ultrasound was used to perform all the blocks. Primary outcome for the comparison was block characteristics, which included sensory and motor block onset, duration, and block satisfaction. The secondary variables used for comparison were analgesic properties and complications. Results: Supraclavicular brachial plexus had rapid onset of sensory and motor block and was statistically significant (P<0.05) as compared to interscalene approach. Similarly, SCBPB had significantly longer duration of sensory block (P=0.003). The duration of motor block was comparable between the blocks. The intraoperative pain score (VAS), requirement of rescue analgesia with in 24 hours of surgery and complications related with the procedures were comparable between the two groups. Majority of the patients were satisfied with either of the approach for brachial plexus block. Conclusion: Supraclavicular brachial plexus block combined with superior cervical plexus block provided equally effective and adequate anesthesia and analgesia for clavicle surgery with comparable complications as compared to interscalene approach.

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