EPIDEMIOLOGY AND COMPLICATIONS OFPERIPHERAL NERVE BLOCKS IN ORTHOPEDICS AND TRAUMATOLOGY : RABAT MILITARYHOSPITAL EXPERIENCE

In recent years, Peripheral Nerve Blocks (PNB) have undergone a significant development due to the simplicity of management of patients under peripheral nerve blocks and especially the quality of postoperative analgesia. This study aims at reviewing the epidemiology and complications of Peripheral nerve blocks. We conducted a prospective surveillance study including all patients who had undergone surgery under peripheral nerve blocks for anesthesia or analgesia in the Trauma Department of the Military Hospital Mohammed V of Rabat over four (4) years. We recorded demographic characteristics, ASA class, effects of puncture, time of performing peripheral nerve blocks, failure, requirement for further block, perioperative and postoperative complications and theirmanagement. One thousand four hundred and twelve (1412) patients underwent nerve blocks during the study period, representing 49% of anesthetic activity in Trauma Department. The mean age is 35 years old. For 85% of patients, the indication of peripheral nerve blocks was advised for anesthesia and 15% PNBwere purely for analgesia. The most performed anesthetic nerve blocks were the infraclavicular blocks followed by blocks at the humeral canal. For analgesia, the ilio-facial and femoral blocks are the most performed. Minor complications are dominated by vascular punctures and paresthesia. As far asmajor complications are concerned, we noticed four (4) cases of convulsions and two (2) cases of neuropathies. Peripheral locoregional anesthesia is an effective and safe method for anesthesia and analgesia. Minor incidents are frequent, serious complications are possible. Their prevention is achieved through compliance to rules on peripheral nerve blocks performance, contraindication, benefit and risk analysis of each block and ultrasound skills.

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THE NEUROPATHIES COMPLICATING PERIPHERAL NERVE BLOCKS: TWO CASES STUDIES

International Journal of Advanced Research ◽

10.21474/ijar01/13433 ◽

2021 ◽

Vol 9 (09) ◽

pp. 463-465

Author(s):

Monsef Elabdi ◽

◽

Abderahmane Elwali ◽

Keyword(s):

Risk Factors ◽

Peripheral Neuropathy ◽

Peripheral Nerve ◽

Postoperative Analgesia ◽

Gold Standard ◽

Case Reports ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Locoregional Anesthesia

Peripheral nerve blocks have become a gold standard for anesthesia and postoperative analgesia in limb and girdle surgeries due to the feeling of security, the simplicity of locoregional anesthesia, the absence of certain adverse effects when general anesthesia and especially in the quality of postoperative analgesia. However, locoregional anesthesia has a certain risk.We present two case reports of peripheral neuropathy after locoregional anesthesia involving the lumbar plexus and median nerve.We discuss through literature review, pathophysiology mechanisms, risk factors, management and prognosis of nerve injury during locoregional anesthesia.

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Igel Phantom: An Innovative Model for USG Guided Needling Training

Journal of Anaesthesia and Critical Care Reports ◽

10.13107/jaccr.2020.v06i02.146 ◽

2020 ◽

Vol 6 (2) ◽

Keyword(s):

Peripheral Nerve ◽

Cost Effective ◽

Ultrasound Guided ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Training Models ◽

Effective Learning ◽

Innovative Model ◽

Keywords Ultrasonography

Advancements in Ultrasonography has increased the interest among anesthesiologists to learn regional anesthesia techniques specially the peripheral nerve blocks. But it takes a long learning curve to become an expert in ultrasound guided regional aneaesthesia techniques. The training models like blue phantom is expensive and not freely available. Other commercially available phantom models like gelatin based phantom and agar based phantoms though cheap has less shelf life .We devised a novel and cost effective learning phantom using Igel for needling training. Further studies are required for comparing the quality of Igel based phantoms with commercially available phantoms like blue phantom. Keywords: Ultrasonography; Igel; Phantom.

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Continuous Peripheral Nerve Blocks in Hospital Wards After Orthopedic Surgery: A Multicenter Prospective Analysis of the Quality of Postoperative Analgesia and Complications in 1,416 Patients

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)70413-9 ◽

2006 ◽

Vol 2006 ◽

pp. 113-114

Author(s):

B.F. Morrey

Keyword(s):

Peripheral Nerve ◽

Postoperative Analgesia ◽

Orthopedic Surgery ◽

Prospective Analysis ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Hospital Wards

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Variation in pediatric local anesthetic dosing for peripheral nerve blocks: an analysis from the Pediatric Regional Anesthesia Network (PRAN)

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101720 ◽

2020 ◽

Vol 45 (12) ◽

pp. 964-969 ◽

Cited By ~ 2

Author(s):

Andreas H Taenzer ◽

Michael Herrick ◽

Matthew Hoyt ◽

R J Ramamurthi ◽

Benjamin Walker ◽

...

Keyword(s):

Peripheral Nerve ◽

Regional Anesthesia ◽

Local Anesthetic ◽

Age Groups ◽

Geographic Location ◽

Average Weight ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Increased Risk ◽

The Mean

BackgroundVariation of local anesthetic dosing has been reported for adult peripheral nerve blocks (PNBs) and infant caudal blocks. As higher doses of local anesthetics (LA) are potentially associated with increased risk of complications (eg, local anesthetic systemic toxicity), it is important to understand the source of LA dose variation. Using the Pediatric Regional Anesthesia Network (PRAN) database, we aimed to determine if variation in dosing exists in pediatric single-injection PNBs, and what factors influence that variation.The primary aim of this study was to determine the factors associated with dosing for the 10 most commonly performed PNBs, with the secondary aim of exploring possible factors for variation such as number of blocks performed versus geographic location.MethodsThe PRAN database was used to determine the 10 most common pediatric PNBs, excluding neuraxial regional anesthetics. The 10 most common pediatric PNBs in the PRAN database were analyzed for variation of LA dose and causes for variation.ResultsIn a cohort of 34 514 children receiving PNBs, the mean age was 10.38 (+/-5.23) years, average weight was 44.88 (+/-26.66) kg and 61.8% were men. The mean bupivacaine equivalent (BE) dose was 0.86 (+/-0.5) mg kg−1 and ropivacaine was used in 65.4% of blocks. Dose decreases with age (estimate −0.016 (−0.017, –0.015; p<0.001)). In all blocks for all age groups, the range of doses that make up the central 80% of all doses exceeds the mean BE dose for the block. Variation is not related to the number blocks performed at an institution (p=0.33 (CI −0.42 to 0.15)). The dose administered for a PNB is driven in order of impact by the institution where the block was performed (Cohen’s ƒ=0.45), then by weight (0.31), type of block (0.27), LA used (0.15) and age (0.03).ConclusionsConsiderable variation in dosing exists in all age groups and in all block types. The most impactful driver of local anesthetic dose is the institution where the block was performed, indicating the dosing of a potentially lethal drug is more based on local culture than on evidence.

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Regional Anesthesia in the Combat Setting: Are ACGME Requirements Enough?

Military Medicine ◽

10.1093/milmed/usz007 ◽

2019 ◽

Vol 184 (11-12) ◽

pp. 745-749 ◽

Cited By ~ 4

Author(s):

Sandeep T Dhanjal ◽

Krista B Highland ◽

Daniel M Nguyen ◽

Danielle M Santos ◽

Robert H Burch ◽

...

Keyword(s):

Peripheral Nerve ◽

Regional Anesthesia ◽

Trauma System ◽

Preliminary Evaluation ◽

Nerve Blocks ◽

Military Health ◽

Peripheral Nerve Blocks ◽

Empirically Supported ◽

Combat Casualty ◽

The Military

Abstract Introduction Updated Joint Trauma System Clinical Practice Guidelines (CPG) indicate regional anesthesia and pain management (RAAPM) are important for combat casualty care. However, it is unclear whether military anesthesiology residents are receiving adequate RAAPM training to meet the CPGs. The goal of this study was to conduct a preliminary evaluation of resident-completed combat-relevant regional anesthesia procedures. It was hypothesized that most residents would perform an adequate number of each procedure to presume proficiency. Materials and Methods Resident-performed, combat-relevant regional anesthesia procedure frequency was extracted from a database maintained at a military anesthesiology residency program. Data collection was limited to a 1-year period. Univariate statistics described procedure distributions, frequencies, and proportion of residents achieving pre-defined, empirically-supported experience criteria for each technique. Analyses examined proportional differences in meeting experience criteria by training-year. Results Residents (N = 41) performed a variety of procedures. Simple procedures, such as saphenous peripheral nerve blocks, were performed at a greater frequency than more complicated procedures such as thoracic epidurals, continuous peripheral nerve blocks, and transverse abdominus plane blocks. The majority of residents met experience criteria for four out of the eight measured combat-relevant blocks. There were no proportional differences in meeting procedural experience criteria across the different training levels. Conclusions These results suggest a possible gap between the needs of the Military Health System during conflict and current residency training experiences. Reasons for this gap, as well as solutions, are explored.

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