scholarly journals Braquial Plexus Block and Lumbosacral Epidural in a South American Coati (Nasua nasua)

2021 ◽  
Vol 49 ◽  
Author(s):  
Lettycia Demczuk Thomas ◽  
Ronaldo José Piccoli ◽  
Paula Eduarda Quintana Bernardi ◽  
Jéssica Fernanda Sinotti ◽  
Viviane Andrade Silva ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Distal Portion ◽  
South American ◽  
X Rays ◽  
Peripheral Nerve Stimulator ◽  
Rescue Analgesia ◽  
Nasua Nasua ◽  
Locoregional Anesthesia ◽  
Plexus Block

Background: The South American coatis (Nasua nasua) are capable of adapting to different habitats, which allowed them to exchange between domestic and wild areas, increasing the occurrence of traumas. Procedures performed in this species demand anesthetic protocols that take comorbidities into account and cause minimal cardiorespiratory depression as well as rapid recovery. It is in such context that locoregional anesthesia has become an essential tool. Thus, we aim to report the use of two techniques of locoreginal block: brachial plexus block and lumbosacral epidural block, in a Nasua nasua submitted to osteosynthesis of the radius and caudectomy due to trauma.Case: A adult male coati weighing 2.3 kg was referred to the Veterinary Medical Teaching Hospital of the Universidade Federal do Paraná (UFPR) - Setor Palotina with a history of trauma. Physical examination showed crackling in the radius and ulnar region, and also abnormal angulation in the distal portion of the tail. After taking x-rays, fractures were confirmed in the distal radius and in the distal portion of the tail. The patient was referred for surgery. After 8 h of water and food withdrawal, the animal was premedicated with a combination of ketamine (10 mg/kg), midazolam (0.3 mg/kg) and methadone (0.2 mg/kg), intramuscularly (IM). Induction of anesthesia was performed with propofol titrated to effect (total dose 4 mg/kg) and anesthesia was maintained with isoflurane in spontaneous ventilation using a non-rebreathing circuit (Baraka). It was evaluated heart rate (HR), respiratory rate (RF), end-tidal CO2 (EtCO2), expired isoflurane fraction (FE´Iso), oxyhemoglobin saturation (SpO2), electrocardiography (ECG), systolic blood pressure (SBP) and core temperature (CT) using a multiparametric monitor. After the stabilization period, the animal was positioned in lateral recumbence. A subscapular brachial plexus block was performed with bupivacaine (0.2 mL/kg) using a peripheral nerve stimulator to ensure the correct perineural deposition of the local anesthetic. During anesthesia, rescue analgesia was administered when there was a 20% increase in HR, RR or SBP compared to baseline values. Thus, in this case, two rescues with fentanyl (2 µg/kg) were necessary. The animal remained stable and, at the end of the first procedure, he was placed in ventral recumbence, with the hindlimbs pulled cranially in order to locate the lumbosacral space. Epidural injection was performed with lidocaine (0.18 mL/kg). Rescue analgesia was not necessary during the caudectomy procedure. The procedure had a total duration of 3 h and extubation occurred 3 min after inhalation anesthesia withdrawal. At the end of the surgery, the animal was medicated with meloxicam (0.1 mg/kg) and methadone (0.2 mg/kg). Two h after the end of the surgery, the animal was able to feed again.Discussion: The literature is scarce regarding anesthetic techniques in the Nasua nasua species, especially in the context of locoregional anesthesia. In this report, the protocol used as pre-anesthetic medication was considered satisfactory. Brachial plexus block is a safe technique for desensitizing the forelimb for surgical procedures distal to the scapulohumeral joint. Despite some morphological differences in the spinal anatomy of coatis, there was no difficulty in identifying the epidural space or inserting the needle. The absence of complications, and the hemodynamic stability during the anesthesia period, combined with the satisfactory recovery of the patient points to the success of the techniques used in the present report.

scholarly journals Nerve Stimulator-Guided Brachial Plexus Block Performed in the Amputation of a Calf’s Forelimb

2019 ◽  
Vol 47 ◽  
Author(s):  
Naftáli Silva Fernandes ◽  
Simone Rodrigues Barbosa ◽  
Maria Gláucia Carlos de Oliveira ◽  
Fábio Franco Almeida ◽  
Desirée Coelho De Mello Seal ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Nerve Stimulation ◽  
Surgical Procedure ◽  
Brachial Plexus Block ◽  
Nerve Stimulator ◽  
Peripheral Nerve Stimulator ◽  
Locoregional Anesthesia ◽  
Amputation Surgery ◽  
Plexus Block

Background: Locoregional anesthesia techniques enable the performance of procedures in the distal portion of the limbs, through the parenteral administration of local anesthetic nerve block. There are devices that can increase the effectiveness of these blocks by accurately locating the nerves. These devices include peripheral nerve stimulators, which enable anesthetic to be injected near the plexus, thus reducing the volume of anesthetic required and allowing for the specific blockade of a nerve branch by desensitizing exclusively the area of interest. This paper describes the use of nerve stimulator in the brachial plexus block (BPB) of a calf subjected to amputation of the left foreleg.Case: A newborn calf weighing 30 kg, with a history of injury to the left foreleg, was treated at the Veterinary Hospital of the Federal Rural University of the Semi-Arid Region. Clinical and X-ray examinations revealed a fracture in the medial portion of the metacarpus and radiographic alterations indicative of osteomyelitis, so amputation of the affected limb was recommended. Prior the beginning, during and after the surgical procedure, the animal was submitted to the evaluation of its physiological parameters (heart and respiratory rate, capillary refill time, diastolic, systolic and mean blood pressure and rectal temperature). Because it is a newborn animal, it was decided not to pre-operatively fast. After applying preanesthetic medication (xylazine 0.01 mg/kg IV), anesthesia was induced with ketamine (2 mg/kg IV) and midazolam (0.3 mg/kg IV) and maintained with isoflurane. For the brachial plexus block, 0.4 mL/kg (1.5 mg/kg) of 0.375% bupivacaine was used and aided by a peripheral nerve stimulator to generate 10 mA current, 1 HZ frequency and 100 μs pulse duration, coupled to a nerve stimulation needle, it was possible to observe flexion movements of the limb. The stimulus was decreased until movements were triggered at currents lower than 5 mA and nonexistent at 2 mA, whereupon the anesthetic solution was slowly injected. The blockade promoted anesthesia of the entire distal region of the scapulohumeral joint after 30 min, providing supplemental analgesia throughout the surgical procedure, whose effect persisted up to 6 h after the blockade, thus enabling amputation surgery of the limb. The anesthetic recovery was smooth and without signs of excitation. Post-operatory therapy was dipyrone (25 mg / kg) intravenously (IV), every 12 h for five days, meloxicam (0.5 mg / kg) IV every 24 h for three days; and morphine (0.1 mg / kg) intramuscularly every 6 h for three days.Discussion: The use of nerve stimulation enabled the safe and effective use of BPB in a calf subjected to forelimb amputation surgery. In terms of its analgesic contribution during the intraoperative period, the effectiveness of the blockade was satisfactory, considering that the animal presented no variations in the parameters evaluated during the entire surgical period, when compared to those obtained in the preoperative, and no supplemental analgesic was needed during the surgery. In cattle, BPB is usually performed using a blind approach, using anatomical points as references for its execution, and the anesthesiologist’s experience and skills are a determining factor in the success rate of the technique. Nerve stimulator-guided plexus block is still rarely used in ruminants, and is described experimentally only in sheep, using a technique similar to that employed for dogs, which means this is a pioneering technique in calves.Naftáli Silva Fernandes, Simone Rodrigues Barbosa, Maria Gláucia Carlos de Oliveira, Fábio Franco Almeida, Desirée Coelho de Mello Seal, Ugo Monteiro de Moraes, Luã Barbalho de Macêdo &Valéria Veras de Paula

scholarly journals Ultrasound guided interscalene brachial plexus block via lower approach for upper limb surgeries

2018 ◽  
Vol 5 (5) ◽  
pp. 1304
Author(s):  
Roopal R. Garaniya ◽  
Sheetal Shah ◽  
Noopur Prajapati
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Interscalene Block ◽  
Ultrasound Guided ◽  
Peripheral Nerve Stimulator ◽  
Interscalene Brachial Plexus Block ◽  
Plexus Block

Background: Brachial plexus block via interscalene approach is an excellent option for upper limb surgeries, but due to sparing of ulnar nerve (lower trunk, C8-T1) and its’ complications, it is not so popular. To overcome this problem, interscalene block via lower approach has been tried which has more advantage in view of ulnar nerve blockage and also less complications. In addition, ultrasound provides reliability, ease, rapidity and also patient comfort during block procedure. This prospective study was performed to evaluate the anaesthetic effect of lower approach interscalene block with the help of ultrasound and peripheral nerve stimulator.Methods: Ultrasound guided interscalene brachial plexus block via lower approach was given in randomly selected 30 patients, undergoing upper limb orthopaedic surgeries. After localisation of brachial plexus with ultrasound, the nerve roots were confirmed with the help of peripheral nerve stimulator, before injecting drug. At 5 and 15 min after block, all patients were assessed for the effect. Postoperatively they were assessed for any complication and also for their satisfaction level by Likert’s scale.Results: In territories of ulnar, radial and musculocutaneous nerve there was 100% effect while in median nerve territory 92.8% motor block was there. There was no need of analgesics during intra operative period in any patient and there were no major complications with this approach.Conclusions: Ultrasound guided interscalene block via lower approach is an excellent alternative for upper limb surgeries over classical approach in view of ulnar nerve blockage without any major complication.

scholarly journals A Comparative Study of Addition of Midazolam to Lignocaine—Bupivacaine vs only Lignocaine— Bupivacaine in Brachial Plexus Block

2016 ◽  
Vol 1 (1) ◽  
pp. 5-9
Author(s):  
Naina P Dalvi ◽  
Harshali Salunkhay ◽  
Shubha N Mohite
Keyword(s):  
Comparative Study ◽  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Control Group ◽  
Study Group ◽  
Motor Blockade ◽  
Peripheral Nerve Stimulator ◽  
Sensory Blockade ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

ABSTRACT Introduction This prospective, randomized, double-blind study compared the onset and duration of sensory blockade, motor blockade, and analgesia with lignocaine, bupivacaine, and midazolam combination vs only lignocaine, bupivacaine in brachial plexus block. Materials and methods Patients of either sex, aged 18–60 years, American Society of Anesthesiologists grade I/II, posted for upper limb surgeries to be performed under supraclavicular brachial plexus block with the help of peripheral nerve stimulator were administered either 10 ml 0.5% bupivacaine with 50 μg/kg midazolam (preservative free) + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine– bupivacaine–midazolam (LBM) or 10 ml 0.5% bupivacaine + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine–bupivacaine (LB). Onset and duration of sensory and motor blockade were monitored. Postoperative analgesia was graded with visual analog scale. Sedation was monitored with Ramsey sedation score. Results A total of 60 patients were randomized to the group LBM (n = 30) and group LB (n = 30). The analgesia was significantly prolonged in the study group, with a mean of 11.72 ± 1.924 hours as compared with a mean of 6.383 ± 1.031 hours in the control group. Sedation scores were higher in the study group, that is, group LBM compared to group LB postoperatively. Conclusion In conclusion, midazolam when added to bupivacaine and adrenalized lignocaine for supraclavicular brachial plexus block hastens the onset of sensory and motor blockade. This combination improves analgesia, as manifested by lower pain scores and prolonged duration of analgesia. How to cite this article Dalvi NP, Salunkhay H, Mohite SN. A Comparative Study of Addition of Midazolam to Lignocaine–Bupivacaine vs only Lignocaine–Bupivacaine in Brachial Plexus Block. Res Inno in Anaesth 2016;1(1):5-9.

Block characteristics of Dexmedetomidine as an adjuvant to local anaesthetic in Infraclavicular brachial plexus block using peripheral nerve stimulator and ultrasound

2021 ◽  
Vol 23 (2) ◽  
pp. 40-46
Author(s):  
Ujma Shrestha ◽  
Sushila Lama Moktan ◽  
Sanjay Shrestha
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Nerve Stimulator ◽  
Ultrasound Guided ◽  
Peripheral Nerve Stimulator ◽  
Infraclavicular Brachial Plexus Block ◽  
Plexus Block

Introduction: Dexmedetomidine has been frequently used in regional anaesthesia to improve the quality of blocks. Addition of dexmedetomidine to local anaesthetics has been shown to hasten the onset of both sensory and motor blocks and also prolong the duration of analgesia. The objective of this prospective comparative study was to assess the change in characteristics of infraclavicular brachial plexus block after adding Inj. Dexmedetomidine to 2% Lignocaine with Adrenaline. Methods: Sixty-six patients, scheduled for upper limb surgeries under ultrasound guided infraclavicular brachial plexus block were randomly allocated to two groups. Group LS received Inj. Lignocaine 2% with Adrenaline, 7mg/kg diluted to 30 ml with saline and Group LD received Inj. Dexmedetomidine 0.75 mcg/kg in addition to Inj. Lignocaine 2% with Adrenaline, 7mg/kg again diluted to a total volume of 30 ml. The parameters studied were: onset of sensory and motor blocks and duration of analgesia. Results: Sixty patients completed the study. The demographic variables and motor block were similar between both groups. The mean time to onset of sensory block was significantly faster in Group LD compared to Group LS (9.80±4.85 min vs 12.30±3.97 min, p=0.033). The duration of analgesia was also found to be prolonged in Group LD compared to Group LS (286.73±55.38 min vs 226.53±41.19 min, p < 0.001). Conclusion: Addition of 0.75 mcg/kg of Dexmedetomidine to 2% Lignocaine with Adrenaline hastens the onset of sensory block and prolongs the duration of analgesia in ultrasound guided and peripheral nerve stimulator guided infraclavicular block.

scholarly journals COMPARISON OF FENTANYL AND DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A RANDOMIZED-DOUBLE BLIND PROSPECTIVE STUDY

2016 ◽  
Vol 9 (5) ◽  
pp. 74 ◽  
Author(s):  
Daisy Karan ◽  
Swastika Swaro ◽  
Swarna Banerjee
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Nerve Blocks ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Sensory Blockade ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

ABSTRACTObjectives: Supraclavicular block of brachial plexus provides complete and reliable anesthesia for upper limb surgeries. Using adjuvant to localanesthetics, blocks can be prolonged to long durations. Peripheral nerve blocks thus help in avoiding the hazards of general anesthesia. We comparedthe sensory blockade, motor blockade, and duration of analgesia with the addition of fentanyl or dexmedetomidine to bupivacaine for supraclavicularbrachial plexus block.Methods: A total of 50 American Society of Anesthesiologist’s Physical Status I and II patients scheduled for elective upper limb surgeries undersupraclavicular brachial plexus block were divided into two equal groups in a randomized double-blinded fashion. Group BF received 30 mlbupivacaine with fentanyl 50 µg and Group BD received 30 ml bupivacaine with dexmedetomidine 50 µg. The characteristics for anesthesia andanalgesia were assessed in both groups.Results: Duration of sensory and motor block was 363.4±38.36 minutes and 357±36.77 minutes, respectively, in Group BF while it was452.96±77.12 minutes and 441.52±48.46 minutes in Group BD. There was a statistically significant difference in onset of sensory and motorblock between the two groups. The duration of analgesia (time to requirement of rescue analgesia) in Group BD was longer than in Group BF(471.44±65.88 minutes vs. 366.48±38.02 minutes) with (p<0.0001). There were minimum hemodynamic disturbances and side effects in any groupexcept for Grade 3 sedation score which was more in Group BD.Conclusion: Dexmedetomidine, when added to bupivacaine in supraclavicular brachial plexus block, enhanced the duration of sensory and motorblock and also the duration of analgesia, more than when fentanyl was added to bupivacaine.Keywords: Fentanyl, Dexmedetomidine, Bupivacaine, Supraclavicular brachial block.

scholarly journals Tramadol as an adjunct to bupivacaine for brachial plexus block.

2019 ◽  
Vol 26 (09) ◽  
pp. 1482-1486
Author(s):  
Afifa Zahoor ◽  
Ranna Mussrat ◽  
Muhammad Ahmad Khan ◽  
Shakeel Ahmad
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
University Hospital ◽  
Orthopedic Procedures ◽  
Controlled Study ◽  
P Value ◽  
Rescue Analgesia ◽  
Group A ◽  
Group B ◽  
Plexus Block

Objectives: To compare the efficacy of tramadol and 0.25% bupivacaine versus 0.25% bupivacaine alone for brachial plexus block. Study Design: Randomized controlled study. Setting: Orthopedic department of Nishtar Medical University/Hospital Multan. Period: The study duration was Jan-2018 to Aug-2018. Material and Methods: 148 patients planned for with upper limb orthopedic procedures under BPB in the department of orthopedics department Nishtar Hospital Multan were included in this analysis. To Patients were randomly divided into two equal groups by lottery method. Group A patients were given solution with 38 ml 0.25% bupivacaine with 100 mg tramadol 2 ml and group B were given solution with 38 ml 0.25% bupivacaine and 2 ml 0.9 % normal saline. Time of onset of block and its duration and need for rescue analgesics were noted. Results: Time of onset of block was 14.56+1.01 minutes in group A versus 15.96+1.64 minutes in group B (p-value <0.001). Mean analgesia duration was 355.85+42.18 minutes in group A versus 310.47+38.79 minutes in group B (p-value <0.001). There were 51 (68.9%) patients in group A who required rescue analgesia and 68 (91.9%) patients in group B required rescue analgesia (p-value 0.004). Conclusion: We concluded that the addition of tramadol as adjunct to bupivacaine for BPB significantly shortens the duration of onset, prolongs the duration of analgesia and reduces the need for rescue analgesics.

scholarly journals Efficacy and safety of ultrasound-guided brachial plexus blocks for upper limb surgery

2015 ◽  
Vol 10 (2) ◽  
pp. 164-171
Author(s):  
Raluca UNGUREANU ◽  
◽  
Liliana MIREA ◽  
Ioana GRINŢESCU ◽  
Dan TULBURE ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Local Anesthetic ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Ultrasound Guided ◽  
Block Success ◽  
Upper Limb Surgery ◽  
Locoregional Anesthesia ◽  
Plexus Block

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.

scholarly journals A Comparison of 0.5% Ropivacaine and 0.5% Bupivacaine for Axillary Brachial Plexus Anaesthesia

1998 ◽  
Vol 26 (5) ◽  
pp. 515-520 ◽  
Author(s):  
D. P. McGlade ◽  
M. V. Kalpokas ◽  
P. H. Mooney ◽  
D. Chamley ◽  
A. H. Mark ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Median Duration ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Local Anaesthetics ◽  
Double Blind ◽  
Peripheral Nerve Stimulator ◽  
Upper Limb Surgery ◽  
Plexus Block

The purpose of this study was to compare the use of 0.5% ropivacaine with 0.5% bupivacaine for axillary brachial plexus anaesthesia. Sixty-six patients undergoing upper limb surgery were enrolled in a double-blind, randomized, multicentre trial. Five patients were subsequently excluded for various reasons. Of the remaining patients, 30 received 40 ml of 0.5%) ropivacaine and 31 received 40 ml of 0.5% bupivacaine. Brachial plexus block was performed by the axillary approach using a standardized technique with a peripheral nerve stimulator. Parameters investigated included the frequency, onset and duration of sensory and motor block, the quality of anaesthesia and the occurrence of any adverse events. The six principal nerves of the brachial plexus were studied individually. The frequency for achieving anaesthesia per nerve ranged from 70 to 90% in the ropivacaine group and 81 to 87% in the bupivacaine group. The median onset time for anaesthesia was 10 to 20 minutes with ropivacaine and 10 to 30 minutes with bupivacaine, and the median duration was 5.3 to 8.7h with ropivacaine and 6.9 to 20.3h with bupivacaine. Motor block was evaluated at the elbow, wrist and hand, and was completely achieved at a rate of 60 to 73% in the ropivacaine group and 55 to 71% in the bupivacaine group. The median duration of motor block was 6.5 to 7.5h with ropivacaine and 6.0 to 9.0h with bupivacaine. These parameters were not statistically different. The duration of partial motor block at the wrist (6.8 v 16.4h) and hand (6.7 v 12.3h) was significantly longer with bupivacaine. Ropivacaine 0.5% and bupivacaine 0.5%) appeared equally efficacious as long-acting local anaesthetics for axillary brachial plexus block.

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