<p>Successful intralipid-emulsion treatment of local anesthetic systemic toxicity following ultrasound-guided brachial plexus block: case report</p>

Introduction. The use of ultrasound (US) for brachial plexus block has increased enthusiasm because the anesthesiologist can visualize anatomy, needle placement, and local anesthetic spread during locoregional anesthesia. The objectives of this prospective study was to evaluate the efficacy and the safety of ultrasound guided brachial plexus block comparative with traditional method of neurostimulation. Material and methods. In this randomized controlled clinical trial we included patients over 18 years old with upper limb surgery and who benefit of brachial plexus block (axillary, interscalenic or combined blocks). After monitoring and sedation, the patients randomly received ultrasound-guided (62 pts.) or neuro stimulation (63 pts.) brachial plexus block with ropivacaine 0.5%. We recorded data about: block success rate, sensitive and motor block onset time, block performance time, immediate and late complications events, patient’s satisfaction rate. The results were statistically analyzed, with significance assumed at p<0.05. Results. Block success rate with ultrasound guidance was very high (93.5% in US group and 84% in NS group). The patients of US group received less volume of local anesthetic (20.89 ± 3.9 ml vs. 43 ± 5.1 ml in NS group, p < 0.05). The performance time, needle punctures, sensory and motor onset time was significant reduced in US group. In the NS group we recorded 2 local anesthetic systemic toxicity (minor-moderate neurologic symptoms) with complete recovery and none in US group. We recorded less paresthesia during block performance and vascular puncture due to US guidance (p<0.05). Patient acceptance with locoregional anesthesia is good, even patients experience more discomfort during neurostimulation technique. Conclusions. The results of this study suggest that both techniques of execution of brachial plexus block are adequate for upper limb surgery but US guidance provides significant benefits for patients in terms of efficacy and safety.

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An Estimation of the Minimum Effective Anesthetic Volume of 2% Lidocaine in Ultrasound-guided Axillary Brachial Plexus Block

Anesthesiology ◽

10.1097/aln.0b013e3181a915c7 ◽

2009 ◽

Vol 111 (1) ◽

pp. 25-29 ◽

Cited By ~ 127

Author(s):

Brian D. O’Donnell ◽

Gabrielle Iohom

Keyword(s):

Brachial Plexus ◽

Local Anesthetic ◽

Brachial Plexus Block ◽

Hand Surgery ◽

Success Rates ◽

Ultrasound Guided ◽

Performance Time ◽

Axillary Brachial Plexus Block ◽

Block Success ◽

Plexus Block

Background Ultrasound guidance facilitates precise needle and injectate placement, increasing axillary block success rates, reducing onset times, and permitting local anesthetic dose reduction. The minimum effective volume of local anesthetic in ultrasound-guided axillary brachial plexus block is unknown. The authors performed a study to estimate the minimum effective anesthetic volume of 2% lidocaine with 1:200,000 epinephrine (2% LidoEpi) in ultrasound-guided axillary brachial plexus block. Methods After ethical approval and informed consent, patients undergoing hand surgery of less than 90 min duration were recruited. A step-up/step-down study model was used with nonprobability sequential dosing based on the outcome of the previous patient. The starting dose of 2% LidoEpi was 4 ml per nerve. Block failure resulted in a dose increase of 0.5 ml; block success in a reduction of 0.5 ml.A blinded assistant assessed sensory and motor blockade at 5-min intervals up to 30 min. Block performance time and duration were measured. Two predetermined stopping points were used; a minimum of five consecutive block success/failures and five consecutive successful blocks at 1 ml per nerve. Results The study was terminated when five consecutive patients had successful blocks using 1 ml of 2% LidoEpi per nerve (overall group n = 11). All five patients had surgical anesthesia within 10 min. The mean (SD) block performance time was 445 (100) s, and block duration was 190 min (range 120-310 min). All surgical procedures were performed under regional anesthesia with anxiolytic sedation provided in 3 of 11 cases. Conclusion Successful ultrasound-guided axillary brachial plexus block may be performed with 1 ml per nerve of 2% LidoEpi.

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