Peripheral Nerve Blocks for the Lower Extremity

2017 ◽  
Author(s):  
Candace Shavit ◽  
Monica W. Harbell
Keyword(s):  
Lower Extremity ◽  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Improve Patient Care ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Peripheral Nerve Catheter

Lower extremity peripheral nerve blocks (PNBs) are often used for surgical anesthesia and postoperative pain management. The use of PNB provides improved analgesia, reduced opioid consumption, and improved patient satisfaction and can facilitate earlier rehabilitation and discharge. As the number of lower extremity total joint arthroplasties is projected to increase significantly, the role of peripheral nerve blocks can be expected to grow in similar fashion. With the growing number of procedures and the increasing focus on patient experience and expeditious hospital discharge, PNBs are increasingly recognized as a powerful tool to improve patient care and facilitate recovery after lower extremity surgery. We provide a basic review of regional anesthesia for lower extremity surgical procedures. The widespread availability of ultrasonography has improved the performance and efficacy of PNBs; thus, we focus on ultrasonography-guided procedures. In this review, we discuss pertinent lower extremity anatomy and sonoanatomy, indications, patient outcome measures, techniques, and complications of the most commonly used blocks. This review contains 35 figures, 11 tables, 5 videos, and 103 references.  Key words: adductor canal block, analgesia, ankle block, clinical applications of peripheral nerve blocks, complications of peripheral nerve blocks, continuous peripheral nerve catheter, early ambulation, fascia iliaca compartment block, femoral nerve block, lower extremity nerve blocks, lower extremity regional anesthesia, lumbar plexus block, obturator nerve block, peripheral nerve block, peripheral nerve catheter, popliteal block, psoas compartment block, regional anesthesia, regional anesthesia techniques, saphenous nerve block, sciatic nerve block, ultrasonography guided

Peripheral Nerve Blocks for the Lower Extremity

2017 ◽  
Author(s):  
Candace Shavit ◽  
Monica W. Harbell
Keyword(s):  
Lower Extremity ◽  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Improve Patient Care ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Peripheral Nerve Catheter

Lower extremity peripheral nerve blocks (PNBs) are often used for surgical anesthesia and postoperative pain management. The use of PNB provides improved analgesia, reduced opioid consumption, and improved patient satisfaction and can facilitate earlier rehabilitation and discharge. As the number of lower extremity total joint arthroplasties is projected to increase significantly, the role of peripheral nerve blocks can be expected to grow in similar fashion. With the growing number of procedures and the increasing focus on patient experience and expeditious hospital discharge, PNBs are increasingly recognized as a powerful tool to improve patient care and facilitate recovery after lower extremity surgery. We provide a basic review of regional anesthesia for lower extremity surgical procedures. The widespread availability of ultrasonography has improved the performance and efficacy of PNBs; thus, we focus on ultrasonography-guided procedures. In this review, we discuss pertinent lower extremity anatomy and sonoanatomy, indications, patient outcome measures, techniques, and complications of the most commonly used blocks. This review contains 35 figures, 11 tables, 5 videos, and 103 references.  Key words: adductor canal block, analgesia, ankle block, clinical applications of peripheral nerve blocks, complications of peripheral nerve blocks, continuous peripheral nerve catheter, early ambulation, fascia iliaca compartment block, femoral nerve block, lower extremity nerve blocks, lower extremity regional anesthesia, lumbar plexus block, obturator nerve block, peripheral nerve block, peripheral nerve catheter, popliteal block, psoas compartment block, regional anesthesia, regional anesthesia techniques, saphenous nerve block, sciatic nerve block, ultrasonography guided

scholarly journals Efficacy of Dexmedetomidine as an Adjuvant to Bupivacaine in Peripheral Nerve Block - Three Prospective Randomized Controlled Studies

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
G M Nassif ◽  
B M E Noreldin ◽  
H M M Elazzazi ◽  
F A Abdelmalek ◽  
M M Maarouf
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Local Anesthetics ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Group I ◽  
Group Ii ◽  
Long Acting

Abstract Introduction Peripheral nerve blocks are frequently used as the sole anesthetic technique or as an adjuvant to general anesthesia, However, the duration of sensory nerve block after single doses of long-acting local anesthetics is not consistent enough to avoid the use of postoperative opioids. Many adjuvants have been added to prolong the duration of nerve block, It was recently suggested that, based on current evidence, perineural dexmedetomidine is the most promising adjuvant to extend the duration of long-acting local anesthetics Aim The aim of this work is to study the effects of dexmedetomidine as an adjuvant to bupivacaine in various peripheral nerve blocks. The study will include: supraclavicular brachial plexus block, paravertebral block and femoral nerve block. Patients Adult patients of either sex aged 25 – 60 years, ASA physical status I and II, Elective surgeries appropriate for the nerve block. Methods patients received bupivacaine 0.5% alone in (group I) or bupivacaine 0.5% combined with 100 dexmedetomidine (group II) in peripheral nerve blocks. Motor and sensory block onset times; durations of blockades and analgesia were recorded Results Sensory and motor block onset times were shorter in group II than in group I. Sensory and motor blockade durations were longer in group II than in group I. Duration of analgesia was longer in group II than in group I. Systolic, diastolic arterial blood pressure levels, and heart rate were less in group II. Conclusion In the current study, it was obvious that:(Addition of dexmedetomidine to bupivacaine in supraclavicular nerve block, paravertebral nerve block and femoral nerve block has shortened the onset times of both sensory and motor blocks and significantly prolonged their durations, Dexmedetomidine had also the added effect of sedation with minimal side effects, which makes it a beneficial adjuvant to local anesthetics in peripheral nerve blocks, Addition of dexmedetomidine to bupivacaine prolonged the postoperative analgesia with subsequent consumption of less amount of analgesics and The use of ultrasonography in performing nerve blocks significantly reduced the incidence of complications such as pneumothorax or intra-arterial injection and hence, lowered the incidence of systemic toxicity of local anesthetics).

scholarly journals Continuous Versus Single-Injection Peripheral Nerve Blocks: A Prospective Cohort Study Comparing Procedural Time and Estimated Personnel Cost

2015 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Brendan Carvalho ◽  
Romy D. Yun ◽  
Edward R. Mariano
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Single Injection ◽  
Clinical Care ◽  
Personnel Cost ◽  
Additional Time ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Physician Time

Background and Objectives: Continuous peripheral nerve blocks (CPNB) provide many additional benefits compared to single-injection peripheral nerve blocks (SPNB). However, the time and costs associated with CPNB provision have not been previously considered. The objective of this study was to compare the time required and estimated personnel costs associated with CPNB and SPNB. Methods: This IRB-exempt observational study involved provision of preoperative regional anesthesia procedures in a “block room” model by a dedicated team during routine clinical care. The primary outcome, the time to perform ultrasound-guided popliteal-sciatic blocks, was recorded prospectively. This time measurement was broken down into individual tasks: time to place monitors, prepare the equipment, scan and identify the target, perform the block, and clean up post-procedure. For peripheral nerve block catheters, time to insert, locate, and secure the catheter was also recorded. Cost estimates for physician time were determined using published national mean hourly wages. Results: Time measurements were recorded for 24 nerve block procedures (12 CPNB and 12 SPNB). The median (IQR; range) total time (seconds) taken to perform blocks was 1132 (1083-1290; 1060-1623) for CPNB versus 505 (409-589; 368-635) for SPNB (Table 1; p<0.001). The median (IQR) cost attributed to physician time during block performance was $35.20 ($33.66-$40.11) and $15.69 ($12.73-$18.32) for CPNB and SPNB, respectively. Conclusion: CPNB requires approximately 10 more minutes per procedure to perform when compared to SPNB. This additional time should be considered along with potential patient benefits and available resources when developing a regional anesthesia and acute pain medicine service.

scholarly journals Ultrasound-Guided Sciatic and Femoral Block in Patient with Recent Embolism Stroke Undergo Amputation Above the Knee

2021 ◽  
Vol 2 (3) ◽  
pp. 116-119
Author(s):  
Propan Hanggada Satyamakti Mubarak ◽  
Keyword(s):  
Peripheral Nerve ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Lower Extremities ◽  
Major Surgery ◽  
Anesthetic Technique ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
The Right

Background: Patients undergoing amputation of the lower extremities usually have poor circulation and other comorbidities and, therefore, present a challenge to the anesthesiologist. The combination of sciatic and femoral nerve block is reported to be an effective anesthetic technique for patients undergoing knee surgery, and it is known to be an effective method of postoperative analgesia in patients undergoing major surgery on the subject's lower extremities. Case: A 70-year-old man with a recent embolism stroke, death of his limb on the right cruris region, and underwent an amputation above the knee. Preoperative physical examination showed GCS E4 V, motor aphasia M6, blood pressure 131/82 mmHg, pulse 114 bpm, RR 20 times/minute with bodyweight 70 kg, height 160 cm, SpO2 97%. There was cyanosis in the right cruric region with motor power of 1/5 1/5. The value of leukocytes 18,600/ul, platelets 309,000/ul, Prothrombin Time (PT) 15.8 seconds, Activated partial thromboplastin time (APTT) 25.9 seconds, International normalized ratio (INR) 1,330, neutrophils 81.7%, lymphocytes 12.6%, creatinine 1.8 mg/dl, urea 137 mg /dl, blood sugar at the time 258 mg/dl, Cl 95 mmol/l. This case report suggests that ultrasound-guided peripheral nerve blocks may be useful for major lower extremity surgery in patients with severe hemodynamic impairment. Conclusion: Perioperative management of embolism stroke patients undergoing above-knee amputation requires special attention in selecting anesthetics. Ultrasound-guided peripheral nerve blocks minimize patient hemodynamic changes and provide better postoperative pain control.

scholarly journals Does Rebound Pain after Peripheral Nerve Block for Orthopedic Surgery Impact Postoperative Analgesia and Opioid Consumption? A Narrative Review

2019 ◽  
Vol 16 (18) ◽  
pp. 3257 ◽  
Author(s):  
Olufunke Dada ◽  
Alicia Gonzalez Zacarias ◽  
Corinna Ongaigui ◽  
Marco Echeverria-Villalobos ◽  
Michael Kushelev ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Opioid Consumption ◽  
Orthopedic Procedures ◽  
Negative Consequences ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
The Impact

Regional anesthesia has been considered a great tool for maximizing post-operative pain control while minimizing opioid consumption. Post-operative rebound pain, characterized by hyperalgesia after the peripheral nerve block, can however diminish or negate the overall benefit of this modality due to a counter-productive increase in opioid consumption once the block wears off. We reviewed published literature describing pathophysiology and occurrence of rebound pain after peripheral nerve blocks in patients undergoing orthopedic procedures. A search of relevant keywords was performed using PubMed, EMBASE, and Web of Science. Twenty-eight articles (n = 28) were included in our review. Perioperative considerations for peripheral nerve blocks and other alternatives used for postoperative pain management in patients undergoing orthopedic surgeries were discussed. Multimodal strategies including preemptive analgesia before the block wears off, intra-articular or intravenous anti-inflammatory medications, and use of adjuvants in nerve block solutions may reduce the burden of rebound pain. Additionally, patient education regarding the possibility of rebound pain is paramount to ensure appropriate use of prescribed pre-emptive analgesics and establish appropriate expectations of minimized opioid requirements. Understanding the impact of rebound pain and strategies to prevent it is integral to effective utilization of regional anesthesia to reduce negative consequences associated with long-term opioid consumption.

scholarly journals Regional Anesthesia For Postdural Puncture Headache (PDPH): A New Solution For An Old Problem? A Systemic Review.

2020 ◽  
Author(s):  
Luca Gregorio Giaccari ◽  
Francesco Coppolino ◽  
Caterina Aurilio ◽  
Valentina Esposito ◽  
Maria Caterina Pace ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Conservative Management ◽  
Systemic Review ◽  
Postdural Puncture Headache ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Occipital Nerve ◽  
Occipital Nerve Block

Abstract Background: Postdural puncture headache (PDPH) is one of the earliest recognized complications of regional anesthesia. It is a common complication after inadvertent dural puncture. When conservative management is ineffective, the Epidural Blood Patch (EBP) is the “gold standard” for the treatment of PDPH. Due to the potential complications of EBP, several alternatives have been promoted as peripheral nerve blocks.A systematic review of the use of regional anesthesia for PDPH is needed to identify an alternative method of pain management.Objectives: To systematically review literature to establish the efficacy and applicability of regional anesthesia used in the treatment of PDPH in the hospital setting.Methods: Embase, MEDLINE, Google Scholar and Cochrane Central Trials Register were systematically searched in May 2020 for studies examining regional anesthesia for PDPH. The methodological quality of the studies and their results were appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and specific measurement properties criteria, respectively.Results: Nineteen studies evaluating peripheral nerve blocks for PDPH were included for a total of 221 patients. Sphenopalatine ganglion block (SPGB), greater occipital nerve block (GONB) and lesser occipital nerve block (LONB) were performed. All participants reported NRS lower than 4 after peripheral nerve blocks at 1, 24 and 48 hours. Only patients who experienced PDPH after diagnostic lumbar puncture reported NRS ≥ 4 after 48 hours. No adverse event was reported after the execution of nerve blocks, except an occasionally discomfort related to the insertion of cotton-tip applicators intranasally for SPGB. 17% of patients underwent a second or more peripheral nerve block due to uncontrolled pain. In 30 participants, EBP was required; none of cases followed spinal anesthesia.Conclusion: Peripheral nerve blocks can be considered as analgesic options in the management of PDPH, as not all cases require EBP for successful treatment. Treatment of PDPH with peripheral nerve blocks seems to be a minimal invasive, easy and effective method, which can offer to patients when conservative management is ineffective.

Continuous Peripheral Nerve Blocks

2019 ◽  
pp. 555-567
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks

This chapter reviews the use of peripheral nerve block catheters in regional anesthesia.

scholarly journals Development of Phantom Limb Pain after Femoral Nerve Block

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Sadiah Siddiqui ◽  
Anthony N. Sifonios ◽  
Vanny Le ◽  
Marc E. Martinez ◽  
Jean D. Eloy ◽  
...  
Keyword(s):  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Subsequent Development ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Pain ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Prevention And Treatment

Historically, phantom limb pain (PLP) develops in 50–80% of amputees and may arise within days following an amputation for reasons presently not well understood. Our case involves a 29-year-old male with previous surgical amputation who develops PLP after the performance of a femoral nerve block. Although there have been documented cases of reactivation of PLP in amputees after neuraxial technique, there have been no reported events associated with femoral nerve blockade. We base our discussion on the theory that symptoms of phantom limb pain are of neuropathic origin and attempt to elaborate the link between regional anesthesia and PLP. Further investigation and understanding of PLP itself will hopefully uncover a relationship between peripheral nerve blocks targeting an affected limb and the subsequent development of this phenomenon, allowing physicians to take appropriate steps in prevention and treatment.

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