scholarly journals A Novel Approach to Brachial Plexus Injections: A Technical Report

2021 ◽  
pp. 19-23
Author(s):  
Myles Dworkin
Keyword(s):  
Pain Management ◽  
Brachial Plexus ◽  
Epidural Space ◽  
Thoracic Epidural ◽  
Novel Approach ◽  
Technical Report ◽  
Introducer Needle ◽  
Pain Symptoms ◽  
Permanent Neurological Deficit

Background: Brachial plexus injects are common procedures for pain management of the upper limb. Complications from theses injections, however, can be severe leading to permanent neurological deficit. The purpose of this technical report is to introduces a safe novel approach for brachial plexus injections. Case Presentation: A 45-year-old woman with type 2 complex region pain disorder underwent a novel brachial plexus injection. The patient was brought to the operating room where fluoroscopy was used to locate the T2 lamina. A 17-gauge introducer needle was maneuvered through the interlaminar space and into the epidural space. The stylet was removed and a Brevi Kath® (Epimed, Dallas, TX) was passed through the C7-T1 foramen into the brachial plexus region. Contrast was used to ensure proper placement and absence of vascular pickup. The injection was then given, and the catheter withdrawn. The procedure was done without complication and the patient had a 40% reduction in pain symptoms based on a visual analog scale. She was cleared to restart physical therapy. Conclusions: This novel technique approaches the brachial plexus by gaining access to the thoracic epidural space and following the spinal nerves through their respective foramen. The use of fluoroscopy and contrast ensures correct placement of injection. A blunt catheter limits the risk of injury. This approach may benefit patients who have failed standard techniques using local landmarks or those that are not ideal candidates due to previous injury or pre-existing conditions. Key words: Interventional pain, injection, brachial plexus, pain management, fluoroscopy

A Pulsatile Pressure Waveform Is a Sensitive Marker for Confirming the Location of the Thoracic Epidural Space

2006 ◽  
Vol 20 (5) ◽  
pp. 659-663 ◽  
Author(s):  
Pamela H. Lennox ◽  
Hamed S. Umedaly ◽  
Raymer P. Grant ◽  
S. Adrian White ◽  
Brett G. Fitzmaurice ◽  
...  
Keyword(s):  
Epidural Space ◽  
Pressure Waveform ◽  
Thoracic Epidural ◽  
Pulsatile Pressure ◽  
Sensitive Marker

scholarly journals Anaesthesia and Postoperative Analgesia Performed by Insertion of a Perineural Catheter at the Brachial Plexus Site - Case Series

2015 ◽  
Vol 61 (3) ◽  
pp. 241-244
Author(s):  
Lazar Alexandra ◽  
Szederjesi Janos ◽  
Copotoiu Sanda Maria ◽  
Simon Noemi Szidonia ◽  
Badea Iudita ◽  
...  
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Brachial Plexus ◽  
Postoperative Analgesia ◽  
Postoperative Period ◽  
Case Series ◽  
Postoperative Pain Management ◽  
Perineural Catheter ◽  
Plexus Block ◽  
Systemic Drug

Abstract Postoperative pain management is of major importance and the existence of a device that ensures a good analgesia in the immediate postoperative period and also removes the side effects of the systemic drugs, is becoming a necessity. Objectives: The goal was to obtain a good quality anaesthesia and also a good postoperative analgesia by inserting a perineural catheter at the brachial plexus site. Material and method: This study included adult patients who underwent brachial plexus anaesthesia through a perineural catheter inserted at the brachial plexus site. The perineural catheter was introduced by ultrasound guidance with neurostimulation control. After insertion, a quantity of a an-aesthetic admixture of 0.4mg/kg is administered. The anaesthetic admixture contained Ropivacaine and Lidocaine, equimolar concentration of 0.5% In the postoperative period, the analgesia was ensured trough the already installed catheter. The analgesic mixture contained Ropivacaine and Lidocaine, equivalent concentrations of 0.25%. The administration rate was 5 ml every 4 hours, starting 6 hours postoperatively. Results: The anaesthesia, obtained through the perineural catheter, was a good quality anaesthesia ensuring both, good sensory and motor block. The feedback regarding postoperative analgesia was positive, this type of pain management being efficient and without the systemic drug side effects. This approach of brachial plexus block was accepted easily by the patients and was rated as a very satisfactory method. Conclusions: The insertion of a perineural catheter for anaesthesia and postoperative analgesia represents a safe and efficient method of achieving both analgesia and anaesthesia.

scholarly journals A novel approach to glycemic control in type 2 diabetes mellitus, partial jejunal diversion: pre-clinical to clinical pathway

2017 ◽  
Vol 5 (1) ◽  
pp. e000431 ◽  
Author(s):  
Martin Fried ◽  
Karin Dolezalova ◽  
Adam P Chambers ◽  
Elliott J Fegelman ◽  
Robin Scamuffa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Clinical Pathway ◽  
Novel Approach

scholarly journals The p38/MK2 Axis in Monocytes of Fibromyalgia Syndrome Patients: An Explorative Study

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 396
Author(s):  
Boya Nugraha ◽  
Renate Scheibe ◽  
Christoph Korallus ◽  
Matthias Gaestel ◽  
Christoph Gutenbrunner
Keyword(s):  
Pain Management ◽  
P38 Mapk ◽  
Fibromyalgia Syndrome ◽  
Mapk Pathway ◽  
Mitogen Activated Protein Kinase ◽  
Pain Syndromes ◽  
Novel Approach ◽  
Mitogen Activated Protein ◽  
The Mean ◽  
Direct Target

Background and Objectives: The aetiology and pathomechanism of fibromyalgia syndrome 12 (FMS) as one of chronic pain syndromes still need to be further elucidated. Mitogen-activated protein kinase (MAPK) pathway has been proposed as a novel approach in pain management. Since the major symptom of fibromyalgia syndrome (FMS) patients is pain, it became of interest whether MAPK pathways, such as the stress-activated p38 MAPK/MK2 axis, are activated in FMS patients. Therefore, this study aimed at determining p38 MAPK/MK2 in FMS patients. Materials and Methods: Phosphorylation of MAPK-activated protein kinases 2 (MK2), a direct target of p38 MAPK, was measured in monocytes of FMS and healthy controls (HCs) to monitor the activity of this pathway. Results: The mean level of phosphorylated MK2 was fivefold higher in FMS patients as compared to HCs (p < 0.001). Subgroup analysis revealed that antidepressants did not influence the activity of MK2 in FMS patients. Conclusions: This result indicates that the p38/MK2 pathway could be involved in the pathomechanism of FMS, could act as a clinical marker for FMS, and could be a possible target for pain management in FMS patients.

scholarly journals Selection of solar tracking system using extended TOPSIS technique with interval type-2 pythagorean fuzzy numbers

2021 ◽  
Author(s):  
Rimsha Umer ◽  
Muhammad Touqeer ◽  
Abdullah Hisam Omar ◽  
Ali Ahmadian ◽  
Soheil Salahshour ◽  
...  
Keyword(s):  
Fuzzy Numbers ◽  
Tracking System ◽  
Weighted Averaging ◽  
Distance Method ◽  
Novel Approach ◽  
Solar Tracking ◽  
Interval Type ◽  
Topsis Technique ◽  
Pythagorean Fuzzy Numbers

AbstractThe Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) is considered among the most frequently used techniques to deal with multi-criteria group decision-making (MCGDM) conflicts. In this article, we have presented an extended TOPSIS technique in the framework of interval type-2 trapezoidal Pythagorean fuzzy numbers (IT2TrPFN). We first projected a novel approach to evaluate the distance between them using ordered weighted averaging operator and $$(\alpha ,\beta )$$ ( α , β ) -cut. Subsequently, we widen the concept of TOPSIS method formed on the distance method with IT2TrPFNs and applied it on MCGDM dilemma by considering the attitudes and perspectives of the decision-makers. Lastly, an application of solar tracking system and numerous contrasts with the other existing techniques are presented to express the practicality and feasibility of our projected approach.

scholarly journals Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use

Children ◽  
2018 ◽  
Vol 5 (12) ◽  
pp. 163
Author(s):  
Genevieve D’Souza ◽  
Anava A Wren ◽  
Christina Almgren ◽  
Alexandra C. Ross ◽  
Amanda Marshall ◽  
...  
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Stress Responses ◽  
Physiological Stress ◽  
Opioid Therapy ◽  
Outpatient Basis ◽  
Opioid Use ◽  
Pediatric Populations ◽  
Special Expertise ◽  
Pain Symptoms

As awareness increases about the side effects of opioids and risks of misuse, opioid use and appropriate weaning of opioid therapies have become topics of significant clinical relevance among pediatric populations. Critically ill hospitalized neonates, children, and adolescents routinely receive opioids for analgesia and sedation as part of their hospitalization, for both acute and chronic illnesses. Opioids are frequently administered to manage pain symptoms, reduce anxiety and agitation, and diminish physiological stress responses. Opioids are also regularly prescribed to youth with chronic pain. These medications may be prescribed during the initial phase of a diagnostic workup, during an emergency room visit; as an inpatient, or on an outpatient basis. Following treatment for underlying pain conditions, it can be challenging to appropriately wean and discontinue opioid therapies. Weaning opioid therapy requires special expertise and care to avoid symptoms of increased pain, withdrawal, and agitation. To address this challenge, there have been enhanced efforts to implement opioid-reduction during pharmacological therapies for pediatric pain management. Effective pain management therapies and their outcomes in pediatrics are outside the scope of this paper. The aims of this paper were to: 1) Review the current practice of opioid-reduction during pharmacological therapies; and 2) highlight concrete opioid weaning strategies and management of opioid withdrawal.

Sign in / Sign up

Export Citation Format

Share Document