Supraclavicular Block: Challenging but Safer Option in Obese Patient During Covid-19 Pandemic

Local Anesthetic Systemic Toxicity ◽

Supraclavicular Block ◽

Plexus Block ◽

Post Bariatric Surgery

Introduction: Brachial plexus block is a boon for an anesthesiologist in difficult airway especially in the COVID-19 pandemic. The provision of regional anesthesia in this pandemic reduces the need for general anesthesia and the associated risk from aerosol-generating procedures. Case Report: A 35-year-old male weighing 130 kg with BMI 39.8 post-bariatric surgery 3 years back presented to casualty with the alleged roadside accident with fracture right midshaft humerus, right radius ulna, multiple facial injuries and suspected C3-C4 fracture. An USG guided supraclavicular block was given using 20 ml 2% lignocaine with adrenaline and 20 ml 0.75% ropivacaine. The patient shifted to COVID-19 post-anesthesia care unit for further management. Discussion: During the COVID-19 pandemic, regional anesthesia though challenging but considered the first choice and safer mode of anesthesia in COVID19 suspected patients with a difficult airway. The advent of USG has made supraclavicular nerve block safe for obese patients and reduce the risk of local anesthetic systemic toxicity. Conclusion: Supraclavicular brachial plexus block provides consistently effective anesthesia to the upper extremity. Also, recent advances in techniques of regional anesthesia have dropped the failure rates of the procedure.

A STUDY TO COMPARE THE EFFICACY OF BUPIVACAINE ALONE AND BUPIVACAINE PLUS DEXAMETHASONE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

10.36106/0631954 ◽

2021 ◽

pp. 1-3

Author(s):

Rupesh Kumar Mishra ◽

Rahul Kumar ◽

Chandeshwar Choudhary ◽

Debarshi Jana

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Block ◽

Age Groups ◽

Onset Time ◽

Nerve Blocks ◽

Anesthetic Care ◽

Duration Of Surgery ◽

Supraclavicular Block ◽

Peripheral nerve blocks can be used for anesthesia, postoperative analgesia, diagnosis and treatment of chronic pain disorders. Skilful application of peripheral nerveblockade broadens the anesthesia provider's range of options in providing optimal anesthetic care. These techniques can be used in all age groups, with appropriate selection and sedation. Present prospective, randomized, double blinded study was conducted at Department of Anaesthesiology, SKMCH, Muzaffarpur, Bihar. Total Sixty consecutive adult patients undergoing upper limb orthopaedic surgeries under supraclavicular block were studied. The patients were drafted in the study after obtaining written informed consent from them. Patients divided in two groups : No statistically signicant difference in the demographic parameters and duration of surgery between the two groups was noted. We, therefore, conclude that addition of 8 mg dexamethasone to bupivacaine 0.25% solution in supraclavicular brachial plexus block. 1) Prolongs the duration of sensory and motor blockade. 2) Reduces the requirement of rescue analgesic in postoperative period. 3) Has no effect on the onset time of sensory and motor blockadc

Efficacy and Safety of Fentanyl as An Adjuvant with Bupivacaine and Lignocaine in Supraclavicular Brachial Plexus Block

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v17i2.39774 ◽

2019 ◽

Vol 17 (2) ◽

pp. 31-35

Author(s):

Sanjida Hasan ◽

Ahmed Abu Nasar Chowdhury ◽

Syeda Nafisa Khatoon ◽

Md Harun OR Rashid ◽

Md Rezaul Hoque Tipu ◽

...

Keyword(s):

Brachial Plexus ◽

Motor Block ◽

Brachial Plexus Block ◽

Efficacy And Safety ◽

College Hospital ◽

Analgesic Effects ◽

Upper Limb Surgery ◽

Supraclavicular Block ◽

Background: Adding narcotics to local anesthetic is very effective in prolonging the analgesic effects. The aim of this study is to evaluation the efficacy and safety of fentanyl as an adjuvant with bupivacaine-lignocaine in supraclavicular block. Methods: This analytical study was carried out in the department of anesthesiology in Chittagong Medical College Hospital in collaboration with the department of orthopedic surgery over a period of 22 months starting from January 2012 to December 2014. A total 130 adult patients of either sex with American Society of Anesthesiology (ASA) health status I-II were selected for upper limb surgery under supraclavicular brachial plexus block was randomly allocated in to two groups of 65 patients in each. Group- C was received Distilled water 2ml and Group-F was received fentanyl 2ml (100 g) in 38ml of bupivacaine and lignocaine with adrenaline (Total volume of 40ml). Results: The mean onset of sensory & motor block was 10.49±0.75 min & 9.41±0.76 min in group-C and 7.60±3.711min & 9.23±5.114min in group-F. The duration of analgesia in group-C was 3.81±0.88 hrs and in group-F was 8.62±1.747 hrs. Conclusion: There was significantly prolonged duration of analgesia and better onset of sensory and motor block in fentanyl group without any unwanted effects. Chatt Maa Shi Hosp Med Coll J; Vol.17 (2); Jul 2018; Page 31-35

Hoarseness of Voice following Left Supraclavicular Brachial Plexus Block: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.7087 ◽

2021 ◽

Vol 59 (241) ◽

pp. 925-928

Author(s):

Subin Shrestha ◽

Sadikshya Regmi ◽

Gopendra Deo ◽

Indra Narayan Shrestha

Keyword(s):

Brachial Plexus ◽

Recurrent Laryngeal Nerve ◽

Brachial Plexus Block ◽

Rare Complication ◽

Local Anaesthetics ◽

Laryngeal Nerve ◽

Ultrasound Guided ◽

Supraclavicular Block ◽

Supraclavicular brachial plexus block is extensively used for primary regional anaesthesia as well as postoperative analgesia for the surgical procedures of the upper limb. The evidence for the use of ultrasound in supraclavicular brachial plexus is growing day by day as it has the advantage of allowing real time visualisation of the plexus, pleura and vessels along with the needle and local anaesthetics spread. Despite this, complications can even arise with ultrasound guided supraclavicular brachial plexus block. Hoarseness of voice due to recurrent laryngeal nerve block is a rare complication of supraclavicular brachial plexus block. There are few reported cases of hoarseness of voice following the right supraclavicular block. There is only one reported case of hoarseness of voice following the left supraclavicular block. Here, we report a case of a 16-year-old boy who developed hoarseness of voice due to left recurrent laryngeal nerve following ultrasound guided left supraclavicular brachialplexus block.

ASSESSMENT OF ANALGESIC EFFICACY OF CLONIDINE AND FENTANYL WITH ROPIVACAINE IN THE SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v2i6.105 ◽

2018 ◽

Author(s):

Krishna Kumar

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Block ◽

Analgesic Efficacy ◽

Systemic Absorption ◽

Duration Of Action ◽

C Fibers ◽

Regional Nerve Block ◽

Supraclavicular Block ◽

Ropivacaine, the S (-) enantiomer of N-(2,6- dimethylphenyl)-1-propyl-2-piperidinecarboxamide is a new long-acting local anesthetic like bupivacaine. Ropivacaine, compared to bupivacaine blocks pain transmitting A-delta and C fibers to a greater extent than A-beta fibers (controlling motor function). Ropivacaine has a wider margin of safety and is less cardiac & neurotoxic compared to bupivacaine with similar duration of action. The fentanyl and clonidine given with local anaesthetic in regional nerve block enhances the block by acting perineurally or it is because of systemic absorption of fentanyl and clonidine administered in block. The current study was planned to compare the efficacy of fentanyl and clonidine as an adjuvants and as an intravenous administration in supraclavicular plexus block with 0.75% ropivacaine. The study was planned in the Department of the Surgery undergoing the Anaesthesia in Sri Krishna Medical College and Hospital, Muzaffarpur, from Jan 2017 to Jun 2017. After obtaining proper informed consent, 40 adult patients of both sexes, aged 18 to 65 years, belonging to ASA I or II and undergoing supraclavicular brachial plexus block were enrolled for this study. The data from the [resent study concludes that the arliest onset of sensory and motor blockade as well as longer duration of analgesia resulted when clonidine 150 µg was used as a perineural adjuvant to Ropivacane 0.75% with minimal side effects compared to its same dose given intravenously. Keywords: supraclavicular block, clonidine, fentanyl , ropivacaine, etc.

A comparative study between Bupivacaine volumes on diaphragmatic mobility in Ultrasound guided Supraclavicular Block

QJM ◽

10.1093/qjmed/hcab086.043 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Israa Tarek Mohamed Abdelaziz ◽

Ahmed Nagah El shaer ◽

Tamer Yousef Elie ◽

Wael Abd Elaziz Mohamed

Keyword(s):

Brachial Plexus ◽

Upper Limb ◽

Brachial Plexus Block ◽

Intravascular Injection ◽

Ultrasound Guided ◽

Group A ◽

Group B ◽

Supraclavicular Block ◽

Abstract Background Brachial plexus is a complex network of nerves supplying the whole upper limb, with both motor and sensory supply. It arises from the neck and passes through the axilla to the upper limb. It is composed of 5 roots, 3 trunks, 6 divisions, 3 cords, and terminal branches. Objective To compare the effect of two different volumes of bupivacaine (20 ml and 25 ml) on diaphragmatic mobility within 15 and 30 minutes from ultrasound guided supraclavicular brachial plexus block in upper limb orthopedic surgeries. Patients and Methods In our study, 40 patients were randomly divided into 2 equal groups. Group A received 20 ml of bupivacaine (0.5%) and group B in which patients received 25 ml of bupivacaibe (0.5%). Diaphragmatic excursion measured in both groups after 15 and 30 mins sequentially. Results Our study showed that the use of low volume of bupivacine has much lower incidence of phrenic nerve affection, and in turn affection of mobility of the diaphragm measured by diaphragmatic excursion. Conclusion Assessment of diaphragmatic excursion is the best indication of phernic nerve injury after supraclavicular block. The use of the ultrasonography is the fastes, easiest and safest method for this assessment. The use of ultrasonography in performing the supraclavicular nerve block decreased significantly the incidence of complications such as pneumothorax or intravascular injection and hence, lowered the incidence of systemic toxicity of local anesthetics.

A Unique Case of Hoarseness of Voice following Left Sided Supraclavicular Block: A Case Report

Nepal Journal of Medical Sciences ◽

10.3126/njms.v5i1.36710 ◽

2020 ◽

Vol 5 (2) ◽

pp. 39-41

Author(s):

Gajal Lakhe ◽

Hari Poudel ◽

Suresh Pradhan ◽

Santosh Dhakal

Keyword(s):

Case Report ◽

Brachial Plexus ◽

Nerve Palsy ◽

Brachial Plexus Block ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Unique Case ◽

Supraclavicular Block ◽

Supraclavicular brachial plexus block is popular for surgeries distal to the level of mid-arm. Though rare, recurrent laryngeal nerve palsy can occur in 1.3% of cases. It has been reported mostly in cases of right-sided block and only one case has been reported on the left side. We present a case of 50-year-old-female patient, who developed hoarseness of voice following a left-sided classical supraclavicular block.

Pulse Oximeter Perfusion Index as a Predictor of Successful Supraclavicular Brachial Plexus Block

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0041-1734211 ◽

2021 ◽

Author(s):

Karthik S. L. ◽

Vishwanath Ankad ◽

Keyword(s):

Brachial Plexus ◽

Upper Limb ◽

Brachial Plexus Block ◽

Prospective Trial ◽

Perfusion Index ◽

Ultrasound Guided ◽

Study Objective ◽

Supraclavicular Block ◽

Abstract Objective Ultrasound-guided supraclavicular brachial plexus block is a popular anesthetic technique for upper limb surgeries. Assessing the success sensory and motor block using conventional methods is time consuming and also it needs patient co-operation. In the present study, objective method like increase in perfusion index is used to predict the success of ultrasound-guided supraclavicular block. Materials and Methods This prospective trial consists of total 95 patients undergoing elective upper limb procedures. All patients received ultrasound-guided supraclavicular block using 0.5% bupivacaine 20 mL. Sensory and motor blocks were evaluated every 5 minutes followed by pinprick testing and ability to flex the elbow and the hand against gravity, respectively. The perfusion index was measured using pulse oximetry applied on the index finger and recorded at baseline and 10, 20, and 30 minutes interval after local anesthetic injection in both the blocked limb and the contralateral unblocked limb using two separate pulse oximeters. Results Perfusion index increased in blocked arm after 5 minutes compared with unblocked arm and also to its baseline value. Both perfusion index and perfusion index ratio in blocked arm were found statistically significant. Conclusion To evaluate the success of supraclavicular block, perfusion index can be considered as a useful tool.

Hemidiaphragmatic paralysis following costoclavicular versus supraclavicular brachial plexus block: a randomized controlled trial

Scientific Reports ◽

10.1038/s41598-021-97843-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Boohwi Hong ◽

Soomin Lee ◽

Chahyun Oh ◽

Seyeon Park ◽

Hyun Rhim ◽

...

Keyword(s):

Pulmonary Function ◽

Brachial Plexus ◽

Chest Radiograph ◽

Brachial Plexus Block ◽

Controlled Trial ◽

Risk Difference ◽

Before And After ◽

Supraclavicular Block ◽

AbstractCostoclavicular brachial plexus block is emerging as a promising infraclavicular approach performed just below the clavicle. However, there are relatively little data regarding the hemidiaphragmatic paralysis (HDP) compared to the commonly performed supraclavicular block. We hypothesized that the incidence of HDP in costoclavicular block is lower than supraclavicular block like classical infraclavicular approach. Eighty patients were randomly assigned to ultrasound-guided supraclavicular (group S) or costoclavicular (group C) block with 25 mL of local anesthetics (1:1 mixture of 1% lidocaine and 0.75% ropivacaine). The primary outcome was the incidence of HDP, defined as less than 20% of fractional change in the diaphragm thickness on ultrasound M-mode. Also, pulmonary function test and chest radiograph were assessed before and after the surgery. The incidence of HDP was 4/35 (11.4%) in the group C and 19/40 (47.5%) in the group S (risk difference, − 36%; 95% CI − 54 to − 17%; P = 0.002). The mean (SD) change of DTF values were 30.3% (44.0) and 56.9% (39.3) in the group C and S, respectively (difference in means, − 26.6%; 95% CI − 45.8 to − 7.4%; P = 0.007). The pulmonary function was more preserved in group C than in group S. The determined diagnostic cut off value of the diaphragm elevation on chest radiograph was 29 mm. Despite the very contiguous location of the two approaches around the clavicle, costoclavicular block can significantly reduce the risk of HDP compared with supraclavicular block.