scholarly journals Successful Treatment of medically refractory scleroderma digital gangrene with long-term continuous brachial plexus block

2019 ◽  
pp. 05-09
Author(s):  
Marcoccia A ◽  
Salvucci C ◽  
Di Carlo M ◽  
Caravelli G ◽  
Bosco M ◽  
...  
Keyword(s):  
Brachial Plexus Block ◽  
Pain Syndrome ◽  
Recurrent Ulcer ◽  
Invasive Treatment ◽  
Delayed Wound Healing ◽  
Digital Ischemia ◽  
Initial Improvement ◽  
Plexus Block ◽  
Artery Reconstruction

Raynaud’s phenomenon (RP) is the earliest and most common clinical manifestation of scleroderma, occurring in 90 to 98% of patients [1]. A combination of sympathetically mediated vasospasm and vasoocclusive disease has been implicated in the etiology of digital ischemic phenomenon [2,3], and treatment of RP is directed towards relieving vasospasm and restoring blood flow. Therefore, cervicothoracic or peripheral sympatholysis and digital artery reconstruction have been performed for medically refractory RP with scleroderma even though all procedures have some limitations. Thoracoscopic symapthectomy has recently been shown to have an initial improvement, although almost always relapses 6 months after the treatment [4,5]. Surgery of the hand, including digital sympathectomy and arterial reconstruction, for scleroderma might have favorable outcomes [6,7]. However, it would be a limited treatment option because of a recurrent ulcer after surgery [8], delayed wound healing [8,9], and development of complex regional pain syndrome [10]. Another alternative and less invasive treatment for blocking the sympathetic outflow would be a sympathetic block with local anesthetics [11,12]. These therapies are based on the premise that excessive sympathetic activity may be involved in the pathogenesis of digital ischemia.

Acute and Nonacute Complications Associated with Interscalene Block and Shoulder Surgery

2001 ◽  
Vol 95 (4) ◽  
pp. 875-880 ◽  
Author(s):  
Alain Borgeat ◽  
Georgios Ekatodramis ◽  
Fabian Kalberer ◽  
Cedric Benz
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Complex Regional Pain Syndrome ◽  
Carpal Tunnel ◽  
Brachial Plexus Block ◽  
Pain Syndrome ◽  
Muscular Weakness ◽  
Interscalene Brachial Plexus Block ◽  
Tunnel Syndrome ◽  
Sulcus Ulnaris ◽  
Plexus Block

Background The incidence, etiology, and evolution of complications after interscalene brachial plexus block (ISB) are not well-known. The authors prospectively monitored 521 patients for complications during the first 9 months after ISB. Methods A total of 521 adults scheduled for elective shoulder surgery performed with an ISB were included in this prospective study. The ISB procedure was standardized for all patients Acute complications were recorded. Patients were observed daily (for 10 days) for paresthesias, dysesthesias, pain not related to surgery, and muscular weakness and were evaluated at 1, 3, 6, and 9 months after surgery. Persistence of paresthesias dysesthesias, pain not related to surgery, or muscular weakness was investigated at 1 or 3 months by means of electroneuromyography. Final evaluation was performed at 9 months. Results A total of 520 patients completed the study; one was excluded after surgical axillary nerve damage. Two hundred thirty-four patients had an interscalene catheter. Acute complications consisted of one pneumothorax (0.2%) and one episode of central nervous system toxicity (incoherent speech; 0.2%). A 10 days, 74 patients (14%) were symptomatic, and none had muscular weakness. At 1 month, 41 patients (7.9%) had symptoms, and none had muscular weakness. Thirty patients under went electroneuromyography; sulcus ulnaris syndrome (n = 8) carpal tunnel syndrome (n = 2), and complex regional pain syndrome (n = 1) were diagnosed. At 3 months 20 patient (3.9%) were symptomatic, and none had muscular weakness All underwent electroneuromyography; carpal tunnel syndrome (n = 2), complex regional pain syndrome (n = 4), plexus neuropathy (n = 1), and plexus damage (n = 1) were diagnosed. At 6 months, 5 patients (0.9%) were symptomatic. At 9 months 1 patient (0.2%) had persistence of dysesthesia. Conclusions Interscalene brachial plexus block performed with a standardized technical approach, material, and drugs is associated with an incidence of short- and severe long-term complications of 0.4%. In case of persistent paresthesia, dysesthesia, or pain not related to surgery after ISB, sulcus ulnaris syndrome, carpal tunnel syndrome, or complex regional pain syndrome should be excluded since specific treatment may be required.

Assessment of Long-Term Vasoplegia Induced by Brachial Plexus Block: A Favorable Effect for Hemodialysis Angioaccess Surgery?

2012 ◽  
Vol 13 (3) ◽  
pp. 296-298 ◽  
Author(s):  
Nicola Pirozzi ◽  
Laura Pettorini ◽  
Jacopo Scrivano ◽  
Anna Giuliani ◽  
Matteo Baldinelli ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Favorable Effect ◽  
Plexus Block

scholarly journals Efficacy and Safety of Two-Level Brachial Plexus Block at Locking Intramedullary Shoulder Osteosynthesis

2016 ◽  
pp. 78-80
Author(s):  
V. B. Dubinenkov ◽  
P. A. Lyuboshevskiy ◽  
S. V. Larionov ◽  
N. A. Koryshkov ◽  
E. V. Shushpanova
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Pain Syndrome ◽  
Control Group ◽  
Efficacy And Safety ◽  
Analog Scale ◽  
Narcotic Analgesics ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block ◽  
The Comparative Study

Results of the comparative study of the efficacy and safety of one- and two-level brachial plexus block (BPB) at locking intramedullary shoulder osteosynthesis are presented. Fifty five patients (mean age 43.4±3.2 years) with humeral diaphysis fracture were operated on. In the main group of patients (n=28) two-level BPB was performed: interscalene block was combined with supraclavicular brachial plexus block and superficial brachial plexus block (SBPB). In control group (n=27) one-level interscalene and superficial BPB and SBPB were performed. Severity of pain syndrome was assessed by visual analog scale. It was shown that two-level BPB ensured better anesthetic, postoperative analgesic effect and higher percent of successful regional anesthesias as well as decreased the requirement in narcotic analgesics on the first postoperative day. The number of complications did not differ significantly between the groups.

scholarly journals Efficacy and Safety of Two-Level Brachial Plexus Block at Locking Intramedullary Shoulder Osteosynthesis

2016 ◽  
Vol 23 (3) ◽  
pp. 78-80
Author(s):  
V. B Dubinenkov ◽  
P. A Lyuboshevskiy ◽  
S. V Larionov ◽  
N. A Koryshkov ◽  
E. V Shushpanova
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Pain Syndrome ◽  
Control Group ◽  
Efficacy And Safety ◽  
Analog Scale ◽  
Narcotic Analgesics ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block ◽  
The Comparative Study

Results of the comparative study of the efficacy and safety of one- and two-level brachial plexus block (BPB) at locking intramedullary shoulder osteosynthesis are presented. Fifty five patients (mean age 43.4±3.2 years) with humeral diaphysis fracture were operated on. In the main group of patients (n=28) two-level BPB was performed: interscalene block was combined with supraclavicular brachial plexus block and superficial brachial plexus block (SBPB). In control group (n=27) one-level interscalene and superficial BPB and SBPB were performed. Severity of pain syndrome was assessed by visual analog scale. It was shown that two-level BPB ensured better anesthetic, postoperative analgesic effect and higher percent of successful regional anesthesias as well as decreased the requirement in narcotic analgesics on the first postoperative day. The number of complications did not differ significantly between the groups.

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