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

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.

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

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.

scholarly journals 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

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

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

2019 ◽  
Author(s):  
Xu-hao Zhang ◽  
Yu-jie Li ◽  
Wenquan He ◽  
Chunyong Yang ◽  
Jianteng Gu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Trial ◽  
Nerve Block ◽  
Nerve Stimulation ◽  
Local Anesthetics ◽  
Ultrasound Guidance ◽  
Female Gender ◽  
Hbv Infection ◽  
Nerve Stimulator ◽  
Nerve Blocks

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

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

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.

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

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.

scholarly journals Epidemiology of Hepatitis B in Canada

2001 ◽  
Vol 12 (6) ◽  
pp. 345-350 ◽  
Author(s):  
Jun Zhang ◽  
Shimian Zou ◽  
Antonio Giulivi
Keyword(s):  
Risk Factors ◽  
Hepatitis B ◽  
Hepatitis B Surface Antigen ◽  
Epidemiological Studies ◽  
Hbv Infection ◽  
Preventive Strategy ◽  
Escape Mutants ◽  
Associated Risk Factors ◽  
Ongoing Surveillance ◽  
The Impact

OBJECTIVE:To provide a current and comprehensive review of the epidemiology of hepatitis B virus (HBV) in Canada.DATA SOURCES:Published and unpublished epidemiological studies and surveillance reports of the past decade, primarily from Canada were studied. Fifty reports addressing HBV surveillance, incidence and prevalence, transmission-associated risk factors, co-infections, and prevention strategies were reviewed.DATA SYNTHESIS:HBV infection is an important vaccine-preventable infectious disease in Canada. The incidence rate of clinically recognized, acute HBV infection in 1998/1999 was estimated to be 2.3/100,000 people or approximately 700 cases a year. The prevalence of HBV carriers is estimated to be 0.5% to 1.0% of the population, but varies substantially according to population-specific risk factors. Most acute HBV infections are associated with injection drug use or high risk heterosexual activities, but 20% to 30% of acute cases did not report any identified risk factors. Surveillance activities such as the National Notifiable Disease Reporting system provide information regarding trends and risk factors. The primary preventive strategy for HBV consists of universal immunization for preadolescents and/or infants. Other strategies, such as the universal prenatal screening and postnatal immunization, and the prevention of nosocomial acquistion, are also important. The recently described hepatitis B surface antigen (HBsAg) escape mutants may not be detected by current HBsAg test assays, and the existing HBV vaccines may not protect vaccinees from infections by such mutants.CONCLUSION:Ongoing surveillance and research are required to assess risk factors for HBV transmission, evaluate the effectiveness of immunization programs and monitor the impact of HBsAg escape mutants.

scholarly journals Exposure time to hepatitis B virus and associated risk factors among children in Edirne, Turkey

2005 ◽  
Vol 133 (3) ◽  
pp. 509-516 ◽  
Author(s):  
M. OTKUN ◽  
M. S. ERDOGAN ◽  
M. TATMAN-OTKUN ◽  
F. AKATA
Keyword(s):  
Risk Factors ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Exposure Time ◽  
Age Groups ◽  
Hbv Infection ◽  
Independent Factor ◽  
B Virus ◽  
Hbsag Seropositivity ◽  
Associated Risk Factors

Hepatitis B virus (HBV) infection is endemic in Turkey, but the main routes of transmission were not well established. This study aims to detect the exposure time to HBV and associated risk factors among children. In a sampling group of chıldren aged 0–19 years living in Edirne, antiHBc, antiHBs and HBsAg were screened by the microELISA method. A questionnaire was also completed for each child. In 717 children that were included in the study, the total antiHBc seropositivity was 5·4% and was 1·8, 0·8, 1·7, 6·8, 11·8% in 0–1, 2–5, 6–10, 11–14, 15–19 years age groups respectively. The overall HBsAg seropositivity was 1·7%. The risk of HBV infection increased after the age of 10 years (OR 7·79, 95% CI 3·01–20·16). Collective circumcision was the only independent factor according to regression analysis. Children living in Edirne should be vaccinated against HBV before reaching 11 years of age.

scholarly journals Dexamethasone with Local Anesthetics Versus Local Anesthetics Alone in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A N Elshaer ◽  
S G A Said ◽  
D S Alawady ◽  
A M Reyad
Keyword(s):  
Brachial Plexus ◽  
Nerve Block ◽  
Local Anesthetics ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Control Group ◽  
Nerve Blocks ◽  
Supraclavicular Brachial Plexus Block ◽  
Prolonged Hospital ◽  
Plexus Block

Abstract Background Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stays and an increased likelihood of chronic pain. Systemic analgesics (opioids and non-opioids) have long been used for postoperative pain, then neuroaxial or peripheral nerve blocks were employed. Local anesthetics alone were used, then various adjuvants were added to achieve quick, dense and prolonged block. Objective The aim of this study was to study the effect of dexamethasone as an adjuvant to bupivacaine in supraclavicular brachial plexus block. The comparison included the onset and the duration of the sensory and motor blocks, the duration of analgesia of the block as well as their effects on the postoperative analgesic requirements. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done. Patients and Methods In our study, 60 patients were randomly divided into 2 equal groups. Control group received bupivacaine only (0.5%) and dexa group in which 8 mg of dexamethasone were added to bupivacaine. All patients received equal volumes of 20 milliliters. Results Our study showed that addition of 8 milligrams of dexamethasone to bupivacaine in ultrasound-guided supraclavicular nerve block shortened the onset times of motor blocks and significantly prolonged motor and sensory block durations. In addition, dexamethasone prolonged the duration of analgesia of the plexus block significantly, as proved by the time of request of analgesia. Moreover, in dexa group, postoperative analgesic requirements were greatly lesser than that of bupivacaine groups. Addition of dexamethasone also did not affect the hemodynamics to a significant level. This makes dexamethasone with bupivacaine more superior than the use of bupivacaine alone. Conclusion Addition of dexamethasone to bupivacaine in supraclavicular nerve block shortened the onset motor blocks. Addition of dexamethasone to bupivacaine significantly prolongs of both sensory and motor block durations.

scholarly journals Application of ultrasound guidance in the oral and maxillofacial nerve block

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12543
Author(s):  
Zhiwei Cao ◽  
Kun Zhang ◽  
Liru Hu ◽  
Jian Pan
Keyword(s):  
Nerve Block ◽  
Anterior Approach ◽  
Ultrasound Guidance ◽  
Anatomical Landmarks ◽  
Nerve Blocks ◽  
Anatomical Structures ◽  
Maxillary Nerve ◽  
Current Article ◽  
Nerve Localization ◽  
Oral And Maxillofacial Regions

Introduction Nerve block technology is widely used in clinical practice for pain management. Conventional nerve localization methods, which only rely on palpation to identify anatomical landmarks, require experienced surgeons and can be risky. Visualization technologies like ultrasound guidance can help prevent complications by helping surgeons locate anatomical structures in the surgical area and by guiding the operation using different kinds of images. There are several important and complex anatomical structures in the oral and maxillofacial regions. The current article reviews the application of ultrasound guidance in oral and maxillofacial nerve blocks. Methods We searched the literature on the use of ultrasound guidance for the main nerve block techniques in the oral and maxillofacial regions using both PubMed and MEDLINE and summarized the findings. Results and Discussion A review of the literature showed that ultrasound guidance improves the safety and effectiveness of several kinds of puncture procedures, including nerve blocks. There are two approaches to blocking the mandibular nerve: intraoral and extraoral. This review found that the role of ultrasound guidance is more important in the extraoral approach. There are also two approaches to the blocking of the maxillary nerve and the trigeminal ganglion under ultrasound guidance: the superazygomatic approach and the infrazygomatic approach. The infrazygomatic approach can be further divided into the anterior approach and the posterior approach. It is generally believed that the anterior approach is safer and more effective. This review found that the effectiveness and safety of most oral and maxillofacial nerve block operations can be improved through the use of ultrasound guidance.

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