scholarly journals ANESTHESIA FOR MICROSURGICAL AUTOTRANSPLANTATION OF TOES ON THE WRIST IN CHILDREN WITH CONGENITAL AND POSTTRAUMATIC PATHOLOGY

2010 ◽  
Vol 16 (1) ◽  
pp. 43-47
Author(s):  
D. V. Zabolotsky ◽  
S. I. Golyana ◽  
N. V. Zaytseva ◽  
A. V. Govorov ◽  
A. G. Kulev ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Postoperative Period ◽  
Local Anesthetics ◽  
Brachial Plexus Block ◽  
Heart Rhythm ◽  
Postoperative Treatment ◽  
Complex Treatment ◽  
Dynamical Study ◽  
Plexus Block

Intraoperative combination of monolateral spinal anesthesia and prolonged brachial plexus block is evaluated in 65 children with autotransplantation of fingers from foot to hand. Variability of heart rhythm demonstrated autonomous stability in the main group. Dynamical study of skin temperature and dopplerographic evaluation demonstrated local sympatholysis in the blocked extremity. Significant improvement of circulation and quality of analgesia is revealed in case of prolonged perineural use of local anesthetics in the postoperative period. Described combination of intra- and postoperative treatment of such patients makes complex treatment more effective.

scholarly journals Local Anesthetic-Induced Central Nervous System Toxicity during Interscalene Brachial Plexus Block: A Case Series Study of Three Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 1013
Author(s):  
Daniel Spitzer ◽  
Katharina J. Wenger ◽  
Vanessa Neef ◽  
Iris Divé ◽  
Martin A. Schaller-Paule ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Brachial Plexus ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Brachial Plexus Block ◽  
Central Nervous System Toxicity ◽  
Interscalene Brachial Plexus Block ◽  
Plexus Block ◽  
System Toxicity

Local anesthetics are commonly administered by nuchal infiltration to provide a temporary interscalene brachial plexus block (ISB) in a surgical setting. Although less commonly reported, local anesthetics can induce central nervous system toxicity. In this case study, we present three patients with acute central nervous system toxicity induced by local anesthetics applied during ISB with emphasis on neurological symptoms, key neuroradiological findings and functional outcome. Medical history, clinical and imaging findings, and outcome of three patients with local anesthetic-induced toxic left hemisphere syndrome during left ISB were analyzed. All patients were admitted to our neurological intensive care unit between November 2016 and September 2019. All three patients presented in poor clinical condition with impaired consciousness and left hemisphere syndrome. Electroencephalography revealed slow wave activity in the affected hemisphere of all patients. Seizure activity with progression to status epilepticus was observed in one patient. In two out of three patients, cortical FLAIR hyperintensities and restricted diffusion in the territory of the left internal carotid artery were observed in magnetic resonance imaging. Assessment of neurological severity scores revealed spontaneous partial reversibility of neurological symptoms. Local anesthetic-induced CNS toxicity during ISB can lead to severe neurological impairment and anatomically variable cerebral lesions.

A rat model of nerve stimulator-guided brachial plexus blockade

2018 ◽  
Vol 53 (2) ◽  
pp. 160-168
Author(s):  
Yanzi Zhang ◽  
Bo Cui ◽  
Chunyu Gong ◽  
Yidan Tang ◽  
Jianxiong Zhou ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Rat Model ◽  
Local Anesthetics ◽  
Brachial Plexus Block ◽  
Motor Blockade ◽  
Efficacy And Safety ◽  
Nerve Stimulator ◽  
Sensory Blockade ◽  
Brachial Plexus Blockade ◽  
Plexus Block

It is important to develop a feasible animal model of regional anesthesia other than sciatic nerve blockade for pharmacokinetic investigations of new local anesthetics or analgesia in upper extremity surgery. Herein, we explored a nerve stimulator (NS)-guided brachial plexus block (BPB) in a rat model. The anatomy of the brachial plexus in rats was delineated in cadavers, and various BPBs were examined. The puncture point was located 0.5–1.0 cm below the lateral one-third of the clavicle. The efficacy and safety of the NS-guided BPB were evaluated using an injection of 2% lidocaine or 0.5% bupivacaine in 16 live animals; saline injection was used as a control. Both sides of the brachial plexus were located successfully using the NS-guided technique. Sensory blockade (nociception assessment) and motor blockade (grasping and straightening tests) appeared after application of the two classical local anesthetics, but not normal saline. The motor and sensory blockade induced by bupivacaine exhibited a longer duration than that induced by lidocaine ( p < 0.05). All rats recovered uneventfully from general anesthesia and BPB. No abnormal results were found in pathological studies or behavioral observations. Thus, a rat model of NS-guided BPB was established, and BPB induced an overall reversible sensory and motor blockade in the thoracic limbs. Evaluation of the efficacy and safety demonstrated that this rat BPB model was feasible, reproducible, and safe.

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.

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