Ultrasound-guided deep nerve block may increase the rate of local anesthetics toxicity in HBV carriers: A Randomized clinical trial

Abstract Background: Ultrasound-guidance might decrease the incidence of local anesthetics systemic toxicity(LAST) for many peripheral nerve blocks compared to nerve stimulation. However, it remained uncertain whether ultrasound-guidance would be superior to the nerve stimulation for deep nerve block in the lower extremity. This study was designed to investigate that deep nerve block with ultrasound-guidance would result in a lower rate of LAST comparing to that with nerve stimulator-guidance. Methods: Three hundred patients who were for elective lower limb surgery and desiring lumbar plexus blocks(LPBs) and sciatic nerve blocks(SNBs) were enrolled in this study. Patients were randomly assigned to receive LPB and SNB with ultrasound-guidance (Group U), nerve stimulator-guidance (Group N) and dual-guidance (Group M). The primary outcome was the incidence of the LAST. The secondary outcomes were number of needle redirections, motor and sensory block onset and restoration times in the nerve distributions, and associated risk factors. Results: There were 18 patients with the LAST, including 12 in group U, 4 in group N and 2 in group M. For multiple comparisons among the tree groups, we found that the incidence of LAST in group U(12%) was significantly higher than that in group N(4%)(P=0.037) and group M(2%)(P=0.006). The OR of LAST with HBV infection and female gender was 3.352(95% CI,1.233-9.108, P=0.013 ) and 9.488(95% CI,2.142-42.093, P=0.0004), respectively. Conclusions: For patients undergoing LPBs and SNBs, use of ultrasound may increase the incidence of the LAST. HBV infection and female gender were risk factors for deep nerve block. Trial registration: This study was approved by the human research review committee at the southwest hospital of third military medical university. The protocol was registered prospectively with Chinese Clinical Trial Registry (ChiCTR-IOR-16008099) on March 15th，2016. Keywords: Ultrasound; nerve stimulation; nerve block; female; HBV; LAST

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Combined Ultrasound and Nerve Stimulator-Guided deep nerve block may decrease the rate of local anesthetics systemic toxicity especially in HBV carriers: A Randomized clinical trial

10.21203/rs.2.185/v2 ◽

2019 ◽

Author(s):

Xu-hao Zhang ◽

Yu-jie Li ◽

Wenquan He ◽

Chunyong Yang ◽

Jianteng Gu ◽

...

Keyword(s):

Risk Factors ◽

Clinical Trial ◽

Nerve Block ◽

Local Anesthetics ◽

Ultrasound Guidance ◽

Female Gender ◽

Hbv Infection ◽

Nerve Stimulator ◽

Nerve Blocks ◽

Associated Risk Factors

Abstract Background: Ultrasound-guidance might decrease the incidence of local anesthetics systemic toxicity(LAST) for many peripheral nerve blocks compared with nerve stimulator-guidance. However, it remained uncertain whether ultrasound-guidance would be superior to the nerve stimulator-guidance for deep nerve block in the lower extremity. This study was designed to investigate that whether ultrasound-guided deep nerve block would decrease the incidence of LAST comparing with those with nerve stimulator-guidance, and to find out associated risk factors for LAST. Methods: Three hundred patients for elective lower limb surgery and desiring lumbar plexus blocks(LPBs) and sciatic nerve blocks(SNBs) were enrolled in this study. Patients were randomly assigned to receive LPBs and SNBs with ultrasound-guidance (Group U), nerve stimulator-guidance (Group N) or dual-guidance (Group M). The primary outcome was the incidence of the LAST. The secondary outcomes were the number of needle redirection, motor and sensory block onset and restoration time in the nerve distributions, and associated risk factors. Results: There were 18 patients occurring with LAST, including 12 in group U, 4 in group N and 2 in group M. For multiple comparisons among the three groups, we found that the incidence of LAST in group U(12%) was significantly higher than that in group N(4%)(P=0.037) and group M(2%)(P=0.006). The OR of LAST with hepatitis B （HBV） infection and female gender were 3.352(95% CI,1.233-9.108, P=0.013 ) and 9.488(95% CI,2.142-42.093, P=0.0004), respectively. Conclusions: Ultrasound-guidance, HBV infection and female gender were risk factors for LAST in LPBs and SNBs. For patients with HBV infection or female gender undergoing LPBs and SNBs, we recommended that combined ultrasound and nerve stimulator-guidance should be used to improve the safety. Trial registration: This study was approved by the Ethical Committee from the first affiliated hospital of Army Medical University. The protocol was registered prospectively with Chinese Clinical Trial Registry (ChiCTR-IOR-16008099) on March 15th，2016. Key words: ultrasound; nerve stimulation; nerve block; female; HBV; LAST

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Combined Ultrasound and Nerve Stimulator-Guided deep nerve block may decrease the rate of local anesthetics systemic toxicity: A Randomized clinical trial

10.21203/rs.2.185/v3 ◽

2019 ◽

Author(s):

Xu-hao Zhang ◽

Yu-jie Li ◽

Wenquan He ◽

Chunyong Yang ◽

Jianteng Gu ◽

...

Keyword(s):

Risk Factors ◽

Clinical Trial ◽

Nerve Block ◽

Local Anesthetics ◽

Ultrasound Guidance ◽

Systemic Toxicity ◽

Hbv Infection ◽

Nerve Stimulator ◽

Nerve Blocks ◽

Associated Risk Factors

Abstract Background: Ultrasound guidance might decrease the incidence of local anesthetics systemic toxicity (LAST) for many peripheral nerve blocks compared with nerve stimulator guidance. However, it remains uncertain whether ultrasound guidance is superior to nerve stimulator guidance for deep nerve block of the lower extremity. This study was designed to investigate whether deep nerve block with ultrasound guidance would decrease the incidence of LAST compared with that with nerve stimulator guidance and to identify associated risk factors of LAST. Methods: Three hundred patients undergoing elective lower limb surgery and desiring lumbar plexus blocks (LPBs) and sciatic nerve blocks (SNBs) were enrolled in this study. The patients were randomly assigned to receive LPBs and SNBs with ultrasound guidance (group U), nerve stimulator guidance (group N) or dual guidance (group M). The primary outcome was the incidence of LAST. The secondary outcomes were the number of needle redirections, motor and sensory block onset and nerve distribution restoration time, as well as associated risk factors. Results: There were 18 patients with LAST, including 12 in group U, 4 in group N and 2 in group M. By multiple comparisons among the three groups, we found that the incidence of LAST in group U (12%) was significantly higher than that in group N (4%) (P=0.037) and group M (2%) (P=0.006). The OR of LAST with hepatitis B (HBV) infection and the female sex was 3.352 (95% CI, 1.233-9.108, P=0.013) and 9.488 (95% CI, 2.142-42.093, P=0.0004), respectively. Conclusions: Ultrasound guidance, HBV infection and the female sex were risk factors of LAST with LPBs and SNBs. For patients infected with HBV or female patients receiving LPBs and SNBs, we recommended that combined ultrasound and nerve stimulator guidance should be used to improve the safety. Trial registration: This study was approved by the Ethical Committee of the First Affiliated Hospital of Army Medical University. The protocol was registered prospectively with the Chinese Clinical Trial Registry (ChiCTR-IOR-16008099) on March 15, 2016.

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Combined Ultrasound and Nerve Stimulator-Guided Deep Nerve Block May Decrease the Rate of Local Anesthetics Systemic Toxicity: A Randomized Clinical Trial

10.21203/rs.2.185/v4 ◽

2019 ◽

Author(s):

Xu-hao Zhang ◽

Yu-jie Li ◽

Wenquan He ◽

Chunyong Yang ◽

Jianteng Gu ◽

...

Keyword(s):

Risk Factors ◽

Clinical Trial ◽

Nerve Block ◽

Local Anesthetics ◽

Ultrasound Guidance ◽

Systemic Toxicity ◽

Hbv Infection ◽

Nerve Stimulator ◽

Nerve Blocks ◽

Associated Risk Factors

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A Randomized Clinical Trial Comparing the Effectiveness of Ultrasound Guidance Versus Nerve Stimulation for Lateral Popliteal-Sciatic Nerve Blocks in Obese Patients

Journal of Ultrasound in Medicine ◽

10.7863/ultra.33.6.1057 ◽

2014 ◽

Vol 33 (6) ◽

pp. 1057-1063 ◽

Cited By ~ 15

Author(s):

Nicholas C. K. Lam ◽

Timothy R. Petersen ◽

Neal S. Gerstein ◽

Tony Yen ◽

Brian Starr ◽

...

Keyword(s):

Clinical Trial ◽

Sciatic Nerve ◽

Randomized Clinical Trial ◽

Nerve Stimulation ◽

Ultrasound Guidance ◽

Obese Patients ◽

Nerve Blocks

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Different Learning Curves for Axillary Brachial Plexus Block: Ultrasound Guidance versus Nerve Stimulation

Anesthesiology Research and Practice ◽

10.1155/2010/309462 ◽

2010 ◽

Vol 2010 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

C. Luyet ◽

G. Schüpfer ◽

M. Wipfli ◽

R. Greif ◽

M. Luginbühl ◽

...

Keyword(s):

Brachial Plexus ◽

Nerve Stimulation ◽

Ultrasound Guidance ◽

Brachial Plexus Block ◽

Learning Curves ◽

Previous Experience ◽

Nerve Stimulator ◽

Nerve Blocks ◽

Axillary Brachial Plexus Block ◽

Plexus Block

Little is known about the learning of the skills needed to perform ultrasound- or nerve stimulator-guided peripheral nerve blocks. The aim of this study was to compare the learning curves of residents trained in ultrasound guidance versus residents trained in nerve stimulation for axillary brachial plexus block. Ten residents with no previous experience with using ultrasound received ultrasound training and another ten residents with no previous experience with using nerve stimulation received nerve stimulation training. The novices' learning curves were generated by retrospective data analysis out of our electronic anaesthesia database. Individual success rates were pooled, and the institutional learning curve was calculated using a bootstrapping technique in combination with a Monte Carlo simulation procedure. The skills required to perform successful ultrasound-guided axillary brachial plexus block can be learnt faster and lead to a higher final success rate compared to nerve stimulator-guided axillary brachial plexus block.

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Combined ultrasound and nerve stimulator-guided deep nerve block may decrease the rate of local anesthetics systemic toxicity: a randomized clinical trial

BMC Anesthesiology ◽

10.1186/s12871-019-0750-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Xu-hao Zhang ◽

Yu-jie Li ◽

Wen-quan He ◽

Chun-yong Yang ◽

Jian-teng Gu ◽

...

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Nerve Block ◽

Local Anesthetics ◽

Systemic Toxicity ◽

Nerve Stimulator

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Intraoperative Nerve Stimulation During Brachial Plexus Surgery: Comparison Between a Totally Disposable Nerve Stimulator and Nerve Stimulator Normally Used for Nerve Blocks

Plastic Surgery ◽

10.1177/2292550317716120 ◽

2017 ◽

Vol 25 (3) ◽

pp. 171-174

Author(s):

Ahmed Thallaj ◽

Wadha M. Alotaibi ◽

Tariq AlZahrani ◽

Abdulaziz S. Abaalkhail ◽

Amel A. F. El-Sayed ◽

...

Keyword(s):

Brachial Plexus ◽

Nerve Stimulation ◽

Ease Of Use ◽

Nerve Stimulator ◽

Nerve Blocks ◽

Group 2 ◽

Materials Used ◽

Disposable Device ◽

Brachial Plexus Surgery ◽

The Cost

Background: Intraoperative nerve stimulation is done routinely in brachial plexus and peripheral nerve surgery as well as in selective neurectomy in spastic patients. Objective: The current study compares the use of 2 different devices for nerve stimulation: a totally disposable nerve stimulator and a nerve stimulator used for nerve blocks by anesthetists. Methods: A retrospective study of 60 patients who underwent brachial plexus surgery: In 30 patients, we used the totally disposable nerve stimulator (group 1) and in another 30 patients, we used the anesthesia device (group 2). The cost of disposable materials used for nerve stimulation was calculated in each group. The same surgeon performed all operations, and he was asked to give his subjective opinion regarding the convenience and ease of use of the device in each group. Results: The main advantages of the totally disposable device are its placement totally within the sterile field, and it is operated by the surgeon without the need to communicate with the anesthetist. However, the totally disposable device had several major disadvantages when compared to the anesthesia device. Firstly, the disposable stimulator can only deliver 0.5, 1.0, and 2.0 mA stimuli, while the anesthesia device can deliver stimuli of 0.1 to 5 mA (in 0.1 mA increments). Secondly, the disposable stimulator frequently fails to operate during surgery, and this is not experienced with the anesthesia device. Finally, the cost of disposables is less using the anesthesia device. Conclusion: Our center has stopped using the disposable nerve stimulator in favour for the anesthesia device.

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Defining the minimal effective volume and amount of lidocaine to perform a femoral nerve block under ultrasound control

10.21203/rs.2.15746/v2 ◽

2020 ◽

Author(s):

Valery Piacherski ◽

Aliaksei Marachkou

Keyword(s):

Sciatic Nerve ◽

Nerve Block ◽

Local Anesthetics ◽

Peripheral Nerves ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

The Body ◽

Effective Volume ◽

Nerve Blocks ◽

Nerve Blockade

Abstract BackgroundThe application of the combination of local anesthetics (LA) in some parts of the body increases the amount of LA and plasma concentration. The aim of our research was to define the minimal effective volume and amount of lidocaine with added adrenaline (1:200,000) to perform a femoral nerve block under ultrasound control and with neurostimulation. MethodsFemoral nerve blockade was performed with the following lidocaine solutions: 0.75% -10 ml, 7.5 ml; 1% -20ml, 15ml, 10ml, 7.5ml, 5ml; 1.5% -5ml, 4ml; 2% -5 ml, 4 ml; 3% -5ml, 4ml, 3ml; 4% -5 ml, 4 ml, 3 ml, 2.5 ml. All blocks were performed with added adrenaline (1:200,000). In all, 181 blocks of the femoral nerve, in combination with sciatic nerve blocks, were carried out with the help of the electrostimulation of peripheral nerves, and under ultrasound. The quality of motor and sensory blocks was assessed after 45 min of administration of the femoral nerve block. ResultsA total of 181 femoral nerve blocks, in combination with sciatic nerve blocks, were used via the help of electrostimulation of the peripheral nerves (EPN), and under ultrasound (US) control. The femoral nerve blockade was effective with the following lidocaine solutions: 0.75% -10 ml (75mg); 1% -20ml, 15ml, 10ml, 7.5ml (75mg); 1.5% -5ml (75mg); 2% -5 ml (100 mg); 3% -5ml (150mg); 4% -5 ml (200mg). Femoral blockade was ineffective when using the following solutions of lidocaine: 0.75% - 7.5ml (56.25 mg); 1% - 5ml (50mg); 1.5% - 4ml (60mg, No spread along the entire circumference of the nerve - NSAECN); 2% - 4 ml (80mg, NSAECN); 3% - 4ml (120mg NSAECN), 3 ml; 4% - 4 ml (160 mg, NSAECN), 3 ml, 2.5 ml. ConclusionFor a complete motor and sensory block of the femoral nerve: the minimum effective volume of local anesthetics was 5 ml; and the minimum effective amount of lidocaine was 75 mg. А complete block of the femoral nerve was achieved only with the spreading of local anesthetic along the whole circumference of the femoral nerve.

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Double axillary vein variation diagnosed with ultrasound guidance during infraclavicular nerve block intervention

BMJ Case Reports ◽

10.1136/bcr-2018-227495 ◽

2019 ◽

Vol 12 (1) ◽

pp. bcr-2018-227495

Author(s):

Başak Altıparmak ◽

Melike Korkmaz Toker ◽

Ali İhsan Uysal ◽

Semra Gümüş Demirbilek

Keyword(s):

Nerve Block ◽

Ultrasound Guidance ◽

Peripheral Nerve Block ◽

Anaesthetic Management ◽

Detailed Knowledge ◽

Axillary Vein ◽

Nerve Blocks ◽

Different Types ◽

Axillary Anatomy ◽

Peripheral Block

The use of ultrasound guidance increases the safety of peripheral block interventions by allowing anaesthesiologists to simultaneously see the position of block needle, the targeted nerves and surrounding vessels. In this report, we represented three patients diagnosed with double axillary vein variation with ultrasound guidance during infraclavicular nerve block intervention. The patients were scheduled for different types of upper limb surgeries. All patients received infraclavicular nerve block for anaesthetic management. A double axillary vein variation was diagnosed with ultrasound during block interventions. Hydro-location technique was used in all cases and the procedures were completed uneventfully. In the current literature, there is limited number of reports concerning double axillary vein variation. Detailed knowledge of the axillary anatomy is important to avoid complications such as intravascular injection during peripheral nerve block interventions. The use of ultrasound guidance and hydro-location technique should be considered for nerve blocks, especially in the axillary area.

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