Novel Regional Nerve Blocks in Clinical Practice: Evolving Techniques for Pain Management

: This review examines the use of novel US-guided nerve blocks in clinical practice. Erector spinae block is a regional anesthesia technique doing by injecting a local anesthetic among the erector spinae muscle group and transverse processes. The phrenic nerve is a branch of the cervical plexus, arising from the anterior rami of cervical nerves C3, C4, and C5. The quadratus lumborum muscle is located along the posterior abdominal wall. It originates from the transverse process of the L5 vertebral body, the iliolumbar ligament, and the iliac crest. US-guided peripheral nerve procedures have a considerable scope of use, including treating headaches and hiccups to abdominal surgical pain, cesarean sections, musculoskeletal pathologies. These nerve blocks have been an effective addition to clinical anesthesia practice. The use of peripheral nerve blocks has improved postoperative pain, lessened the use of opioids and their potential side effects, and decreased the incidence of sleep disturbance in patients. More research should be done to further delineate the potential benefits of these blocks.

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Ultrasound Guidance for Deep Peripheral Nerve Blocks: A Brief Review

Anesthesiology Research and Practice ◽

10.1155/2011/262070 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Anupama Wadhwa ◽

Sunitha Kanchi Kandadai ◽

Sujittra Tongpresert ◽

Detlef Obal ◽

Ralf Erich Gebhard

Keyword(s):

Peripheral Nerve ◽

Regional Anesthesia ◽

Nerve Stimulation ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Sense Of Security ◽

False Sense ◽

Anesthesia Technique ◽

Additional Value

Nerve stimulation and ultrasound have been introduced to the practice of regional anesthesia mostly in the last two decades. Ultrasound did not gain as much popularity as the nerve stimulation until a decade ago because of the simplicity, accuracy and portability of the nerve stimulator. Ultrasound is now available in most academic centers practicing regional anesthesia and is a popular tool amongst trainees for performance of nerve blocks. This review article specifically discusses the role of ultrasonography for deeply situated nerves or plexuses such as the infraclavicular block for the upper extremity and lumbar plexus and sciatic nerve blocks for the lower extremity. Transitioning from nerve stimulation to ultrasound-guided blocks alone or in combination is beneficial in certain scenarios. However, not every patient undergoing regional anesthesia technique benefits from the use of ultrasound, especially when circumstances resulting in difficult visualization such as deep nerve blocks and/or block performed by inexperienced ultrasonographers. The use of ultrasound does not replace experience and knowledge of relevant anatomy, especially for visualization of deep structures. In certain scenarios, ultrasound may not offer additional value and substantial amount of time may be spent trying to find relevant structures or even provide a false sense of security, especially to an inexperienced operator. We look at available literature on the role of ultrasound for the performance of deep peripheral nerve blocks and its benefits.

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Assessing the current status of continuous peripheral nerve blocks in clinical practice in North America, a survey approach

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2020.109870 ◽

2020 ◽

Vol 65 ◽

pp. 109870

Author(s):

Sanjib Adhikary ◽

Alexandra Sideris ◽

Mary Hargett ◽

Nabil M. Elkassabany ◽

Edward R. Mariano ◽

...

Keyword(s):

Clinical Practice ◽

North America ◽

Peripheral Nerve ◽

Current Status ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Survey Approach

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A review of peripheral nerve blocks for cesarean delivery analgesia

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-100752 ◽

2019 ◽

Vol 45 (1) ◽

pp. 52-62 ◽

Cited By ~ 5

Author(s):

Kelsey D Mitchell ◽

C Tyler Smith ◽

Courtney Mechling ◽

Charles B Wessel ◽

Steven Orebaugh ◽

...

Keyword(s):

Peripheral Nerve ◽

Cesarean Delivery ◽

Multimodal Analgesia ◽

Erector Spinae ◽

Transversus Abdominis ◽

Future Research ◽

Wound Infiltration ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Emergency Cesarean

Peripheral nerve blocks have a unique role in postcesarean delivery multimodal analgesia regimens. In this review article, options for peripheral nerve blocks for cesarean delivery analgesia will be reviewed, specifically paravertebral, transversus abdominis plane, quadratus lumborum, iliohypogastric and ilioinguinal, erector spinae, and continuous wound infiltration blocks. Anatomy, existing literature evidence, and specific areas in need of future research will be assessed. Considerations for local anesthetic toxicity, and for informed consent for these modalities in the context of emergency cesarean deliveries, will be presented.

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Regional Peripheral Nerve Blocks-A Procedural Model for Safe Clinical Practice

Journal of PeriAnesthesia Nursing ◽

10.1016/j.jopan.2011.04.033 ◽

2011 ◽

Vol 26 (3) ◽

pp. 189

Author(s):

Helen Kurtzke ◽

Loretta Simckowitz ◽

Diane Noto

Keyword(s):

Clinical Practice ◽

Peripheral Nerve ◽

Nerve Blocks ◽

Peripheral Nerve Blocks

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Peripheral Nerve Blocks and Lesioning and Surgical Pain Management

Academic Pain Medicine ◽

10.1007/978-3-030-18005-8_19 ◽

2019 ◽

pp. 111-123

Author(s):

Alan David Kaye ◽

Elyse M. Cornett ◽

Chris J. Cullom ◽

Susan M. Mothersele ◽

Yury Rapoport ◽

...

Keyword(s):

Pain Management ◽

Peripheral Nerve ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Surgical Pain

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Ultrasound Guided Continuous Quadratus Lumborum Block as a Perioperative Analgesic Technique for Pyeloplasty in a Paediatric Patient : A Case Report

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i1.29641 ◽

2020 ◽

Vol 5 (1) ◽

pp. 995-998

Author(s):

Rupesh Kumar Yadav ◽

Bidur Dhungel ◽

Bijay Thapa

Keyword(s):

Peripheral Nerve ◽

Promising Result ◽

Psychological Trauma ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Quadratus Lumborum Block ◽

Quadratus Lumborum ◽

Analgesic Technique

With the use of ultrasound, peripheral nerve blocks can be more precise and deposition of local anesthetics under direct vision reduces drug volume and minimizes untoward toxicity. Its extensive use in peri-operative period add a safety measures to reduce procedural complications. Pain in children's are often under recognized and under treated which can lead to emotional, psychological trauma for rest of their life. Peripheral nerve blocks have the advantage of greater overall safety and efficacy for lower abdominal surgeries. An abdominal truncal block technique known as Quadratus Lumborum block has emerged recently with a goal of anesthetizing the thoracolumbar nerves for somatic as well as visceral analgesia of both lower and upper abdomen. A sound knowledge of sensory supply to the genitourinary system is important for the success of regional anesthesia. We report a case of four years old child who was diagnosed as left sided pelvic ureteric junction obstruction and was planned for pyeloplasty where continuous quadratus lumborum block was used as a mode of post operative analgesia which showed a promising result. Antibiotic resistance and lack of newer effective antibiotic against multidrug resistant bacteria like Acinetobacter baumannii is a common problem in intensive care unit. Trimethoprim -Sulfamethoxazole may help in combating this problem.

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Continuous peripheral nerve blocks in clinical practice

Current Opinion in Anaesthesiology ◽

10.1097/aco.0b013e32830c66c2 ◽

2008 ◽

Vol 21 (5) ◽

pp. 619-623 ◽

Cited By ~ 38

Author(s):

Xavier Capdevila ◽

Matthieu Ponrouch ◽

Olivier Choquet

Keyword(s):

Clinical Practice ◽

Peripheral Nerve ◽

Nerve Blocks ◽

Peripheral Nerve Blocks

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Peripheral Nerve Block and Ultrasound Images

10.1093/med/9780190457006.003.0008 ◽

2018 ◽

Author(s):

Paul K. Cheng ◽

Tariq M. Malik ◽

Magdalena Anitescu

Keyword(s):

Peripheral Nerve ◽

Regional Anesthesia ◽

Postoperative Pain Management ◽

Ultrasound Images ◽

Nerve Blocks ◽

Opioid Prescription ◽

Peripheral Nerve Blocks ◽

Surgical Pain ◽

History Of ◽

Chronic Post Surgical Pain

Ultrasound-guided peripheral nerve blocks can be used as the primary anesthetic for surgery involving the extremities and trunk and as a modality for opioid-sparing postoperative pain management. Success of regional anesthesia is dependent upon depositing local anesthetics in the correct plane. Advent of ultrasound has made this process more efficient, safer, and less painful for the patient More prevalent use of regional anesthesia in the perioperative setting will limit opioid prescription, development of chronic post surgical pain and is known to improve patient satisfaction by improving pain. This chapter reviews the history of ultrasound use for nerve blocks and basics of ultrasound use. It also discusses common peripheral nerve blocks of the upper extremities, trunk area, and lower extremities and summarizes indications, techniques, and key complications. Included are ultrasound images for each block.

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