Microsurgical procedures for peripheral nerve lesions: Choice of anesthesia

Microsurgical procedures on peripheral nerve lesions have their own specifics. Those are: duration and extent of operation, and need to change body position during operation. General endotracheal anesthesia has been used for operations on brachial plexus lesions with neural transpher; on peripheral nerve lesions with sural nerve autotransplantations; on all extracranial lesions (facial n. and lesion hypoglossal n.); for lesions of plexus lumbalis and sciatic nerve. These operations are requesting turning of patient on the lateral or ventral position or they are performed on head and neck. Because operation and anesthesia last longer, general ET anesthesia is more suitable for neurosurgens and anesthesiologist's interventions. Regional anesthesia, i.e. neural plexus block, is suitable for operations on upper extremity. Then we perform brachial plexus block with more approaches. There has been frequently in use axillary approach which is easier to perform, has minimum of complications and is suitable for procedures at cubital region, forearm and hand.

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Four-Injection Brachial Plexus Block Using Peripheral Nerve Stimulator: A Comparison Between Axillary and Humeral Approaches

Anesthesia & Analgesia ◽

10.1213/00000539-200210000-00053 ◽

2002 ◽

Vol 95 (4) ◽

pp. 1075-1079

Author(s):

Salvatore Sia ◽

Antonella Lepri ◽

Maria Consolata Campolo ◽

Rossana Fiaschi

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Brachial Plexus Block ◽

Nerve Stimulator ◽

Peripheral Nerve Stimulator ◽

Plexus Block

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

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20183913 ◽

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.

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Comparison of Patient Satisfaction between Brachial Plexus Block (Axillary Approach) and General Anesthesia for Surgical Treatment of Distal Radius Fractures: A Historical Cohort Study

Open Journal of Anesthesiology ◽

10.4236/ojanes.2020.1012037 ◽

2020 ◽

Vol 10 (12) ◽

pp. 422-434

Author(s):

Noriaki Matsumura ◽

Satoki Inoue ◽

Hidenobu Iwagami ◽

Yumiko Kondo ◽

Kazuya Inoue ◽

...

Keyword(s):

Cohort Study ◽

Patient Satisfaction ◽

Surgical Treatment ◽

Brachial Plexus ◽

General Anesthesia ◽

Brachial Plexus Block ◽

Radius Fractures ◽

Historical Cohort ◽

Axillary Approach ◽

Plexus Block

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

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v23i2.35833 ◽

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.

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