Using the BBraun BSmartTM Pressure Manometer to Prevent Unsafe Injection Pressures During Simulated Peripheral Nerve Blockade: A Pilot Study

Background: Peripheral nerve injury during regional anaesthesia may result from accidental intraneural placement of the needle, or forceful needle nerve contact. Intraneural injections are associated with increased resistance to injection, typically >15 psi. The BBraun BSmart™ is an inline mechanical manometer, offering a visual display of injection pressures. Objective: The primary objective of this study was to determine if using the BBraun BSmartTM manometer successfully prevents 90% of anaesthetists and anaesthetic assistants from injecting at pressures > 15 psi during simulated nerve block. Methods: This was a prospective observational study involving anaesthetists and anaesthetic assistants. Two 20 ml injections were performed by each participant, once when the BBraun BSmartTM manometer was obscured from view, and once with the manometer visible. A PendoTech PressureMATTMS recorded injection pressures. Results: 39 participants completed the study, with a total of 78 injections recorded. During the study, 32 peak pressures during the 78 procedures were recorded above the recommended upper limit of 15 psi, 41% of the total injections. The peak pressure rose above 15 psi in 24/39 (62%) injections when the BBraun Bsmart™ manometer was obscured, but only in 8/39 (21%) injections when the manometer was visible. Conclusion: The BBraun Bsmart™ manometer did not successfully prevent 90% of anaesthetists or anaesthetic assistants from injecting at unsafe pressures. However, using the BBraun BSmart™ did reduce the number of unsafe injection pressures generated by participants. When utilised in conjunction with PNS and ultrasound guidance, this may offer additional safety during peripheral nerve blockade.

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Faculty Opinions recommendation of Efficacy of supplemental peripheral nerve blockade for hip fracture surgery: multiple treatment comparison.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717976548.793472205 ◽

2013 ◽

Author(s):

Andreas Hoeft

Keyword(s):

Hip Fracture ◽

Peripheral Nerve ◽

Nerve Blockade ◽

Hip Fracture Surgery ◽

Multiple Treatment ◽

Treatment Comparison ◽

Peripheral Nerve Blockade ◽

Multiple Treatment Comparison ◽

Fracture Surgery

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Predictors of hospital admission after rotator cuff repair: the role of peripheral nerve blockade

European Journal of Anaesthesiology ◽

10.1097/00003643-201306001-00423 ◽

2013 ◽

Vol 30 ◽

pp. 135-136

Author(s):

O. Stundner ◽

T. Danninger ◽

R. Rasul ◽

M. Mazumdar ◽

P. Gerner ◽

...

Keyword(s):

Rotator Cuff ◽

Peripheral Nerve ◽

Hospital Admission ◽

Rotator Cuff Repair ◽

Nerve Blockade ◽

Peripheral Nerve Blockade ◽

Cuff Repair

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Cardiac Arrest due to Failed Pacemaker Capture After Peripheral Nerve Blockade With Levobupivacaine: A Case Report

A & A Practice ◽

10.1213/xaa.0000000000001445 ◽

2021 ◽

Vol 15 (4) ◽

pp. e01445

Author(s):

Asuka Kitajima ◽

Takeshi Nakatomi ◽

Yuji Otsuka ◽

Masamitsu Sanui ◽

Alan Kawarai Lefor

Keyword(s):

Cardiac Arrest ◽

Case Report ◽

Peripheral Nerve ◽

Nerve Blockade ◽

Peripheral Nerve Blockade

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A COMPREHENSIVE ANESTHESIA PROTOCOL THAT EMPHASIZES PERIPHERAL NERVE BLOCKADE FOR TOTAL KNEE AND TOTAL HIP ARTHROPLASTY

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200511002-00008 ◽

2005 ◽

Vol 87 ◽

pp. 63-70 ◽

Cited By ~ 1

Author(s):

JAMES R. HEBL ◽

SANDRA L. KOPP ◽

MIR H. ALI ◽

TERESE T. HORLOCKER ◽

JOHN A. DILGER ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Peripheral Nerve ◽

Hip Arthroplasty ◽

Nerve Blockade ◽

Total Hip ◽

Peripheral Nerve Blockade ◽

Total Knee

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Anatomical Considerations for Peripheral Nerve Blockade

Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade ◽

10.1093/med/9780199743032.003.0005 ◽

2010 ◽

pp. 51-94

Author(s):

James R. Hebl

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Surface Orientation ◽

Lumbar Plexus ◽

Lumbosacral Plexus ◽

Motor Innervation ◽

Nerve Blockade ◽

Peripheral Nerve Blockade

Chapter 5 contains a basic review of terminology used to describe body planes, surface orientation, and movements. The anatomy of major nerve plexuses are also examined: brachial plexus, lumbar plexus, lumbosacral plexus. The chapter concludes with a discussion of peripheral nerve anatomy and sensory and motor innervation, including dermatomes, osteotomes, and myotomes.

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Az ultrahang-képalkotás alkalmazása biotechnikai előrelépés a perioperatív fájdalomcsillapításban

Orvosi Hetilap ◽

10.1556/650.2019.31374 ◽

2019 ◽

Vol 160 (15) ◽

pp. 573-584

Author(s):

Róbert Gyula Almási

Keyword(s):

Nervous System ◽

Pain Management ◽

Side Effects ◽

Postoperative Pain ◽

Peripheral Nerve ◽

General Anaesthesia ◽

Central Sensitization ◽

Regional Anaesthesia ◽

Nerve Blockade ◽

Peripheral Nerve Blockade

Abstract: The perioperative pain management – instead of the efforts, guidelines and protocols – is underestimated and undertreated. Even in the case of general anaesthesia, the nervous system is overwhelmed by copious quantities of nociceptive stimuli at surgical incision. Stress and pain-modulation processes are triggered which can have significant influence on the outcome. Often the pain-management is discontinued, so a notable part of patients complain about pain in the ward after surgery. Regional anaesthesia conceptually prevents noxious inputs to enter the central nervous system, beyond surgical anaesthesia it is pertinent to achieve excellent analgesia in the immediate postoperative period as well. Based on current literature, this paper provides an overview of the history and role of regional anaesthesia in the multidimensional model of pain. Besides the sensitization caused by nociceptive stimuli – peripheral and central sensitization, descending modulation – there are several biopsychosocial factors involved in pain pathophysiology. Preventing the side effects of general anaesthesia, the ultrasound-guided peripheral nerve blockade is a safe technique with high success rate, rare side effects, achieving long-lasting, excellent analgesia. Continuous perineural catheter placed under ultrasound provides extended pain control. As a part of multimodal analgesia, peripheral nerve blockade prevents central sensitization. After surgery, the pain intensity of patients under peripheral nerve blockade is less, the chronification tendency is decreased, the quality of life and patients’ comfort are improved, and the stress-response is attenuated. The greater part of patients are protected from the undesirable side effects of general anaesthesia. Nowadays, it is an unequivocal evidence that the increasingly used peripheral nerve blockades prior to incision are efficient tools in the prevention of chronic postoperative pain. Ultrasound guidance is suitable not only for surgical anaesthesia, but for postoperative pain management as well, however, besides economic factors, the main goal of this technique is to match the best interest of the patients. Orv Hetil. 2019; 160(15): 573–584.

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First Year Specialist Anaesthesia Training in Ireland: A Logbook Analysis

International Journal of Higher Education ◽

10.5430/ijhe.v6n6p106 ◽

2017 ◽

Vol 6 (6) ◽

pp. 106

Author(s):

SM O’Shaughnessy ◽

CJ Skerritt ◽

CW Fitzgerald ◽

R Irwin ◽

F Walsh

Keyword(s):

Peripheral Nerve ◽

Retrospective Analysis ◽

Central Line ◽

First Year ◽

Arterial Line ◽

Direct Supervision ◽

Central Lines ◽

Nerve Blockade ◽

Spinal Anaesthetic ◽

Peripheral Nerve Blockade

Objective:Acquisition of a new range of skills occurs during first year anaesthesia training. At present, no defined logbook targets exist for the Irish anaesthesia trainee.The aim of this study was to quantify the number of practical procedures performed and supervision required during first year anaesthesia training.Methods:A retrospective analysis of prospectively maintained logbooks of three first year anaesthesia trainees was performed.Results:In the first three months, mean numbers of cases were 224, enodotrachael tube (ETT) 64, laryngael mask airway (LMA) 55, spinal anaesthetic 12, arterial lines 9.5, central lines 0.5, peripheral nerve blockade (PNB) 2, epidurals 0. There was 91.5% direct supervision and 8.5% indirect supervision.In the final three months, mean numbers of cases were 205.5, ETT 28, LMA 35, spinals 50, arterial line insertions 4.5, central line insertions 1.5, PNB 3.5, epidurals 80. There was 68.5% direct supervision and 31.5% indirect supervision.Conclusions:Defined logbook targets are needed to quantify trainee progress.

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Lower-Extremity Sclerotomes

Journal of the American Podiatric Medical Association ◽

10.7547/0980232 ◽

2009 ◽

Vol 99 (3) ◽

pp. 232-235 ◽

Cited By ~ 3

Author(s):

Andrew J. Meyr ◽

Raymond DiPrimio

Keyword(s):

Lower Extremity ◽

Peripheral Nerve ◽

Spinal Nerve ◽

Sensory Innervation ◽

Diagnosis And Treatment ◽

Deep Fascia ◽

Nerve Blockade ◽

Anatomical Knowledge ◽

Peripheral Nerve Blockade

A sclerotome is an anatomical concept that defines an area of bone supplied by a single spinal nerve. Similar to the familiar dermatomes, sclerotomes provide an element of depth to the sensory innervation of the lower extremity based on the deep fascia as an embryologic boundary. Anatomical knowledge of sclerotomes can be used clinically in the diagnosis and treatment of pain and in the perioperative setting. Specifically, a modified version of the classic Mayo block is presented to highlight an active anatomical approach to peripheral nerve blockade. (J Am Podiatr Med Assoc 99(3): 232–235, 2009)

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