Ultrasound Guided Brachial Plexus Block in Upper Extremity Surgeries: Experiences from a Tertiary Care Hospital of Bangladesh

Brachial plexus block has been gained popularity after its introduction because of provision of quality anesthesia and optimal postoperative analgesia in upper arm surgeries, and introduction of ultrasound guidance in recent years further enhances the practice because of efficacy and safety of procedure. This retrospective observational study evaluated the outcome and safety of ultrasound-guided brachial plexus block (supraclavicular and interscalene approach) in a tertiary care hospital of Bangladesh over 3-years period (January 2017 to December 2019) through analyzing preoperative anesthesia evaluation form, anesthesia documents and postoperative records. 113 patients were covered during the study period, of which 59 (52.2%) were males and 54 (47.8%) were females. Majority of the patients (63.7%) were in ASA grading I. Operative time for surgeries were 115.30 minutes. duration of sensory and motor block were 618 minutes and 450 minutes respectively. And first dose of postoperative analgesic was given after 705 minutes of surgery. Tachycardia and hypertension were observed in 4.4% patients, where failure of motor blockade and puncture of subclavian vein were recorded 1.8% and 0.9% respectively. Current study found that with ultrasound guidance in skilled hands, brachial plexus blockade through combination of supraclavicular and interscalene approaches can provide quality anesthesia and analgesia with minimal complications.

Erector Spinae Plane Block in the Emergency Department for Upper Extremity: A Case Report

Introduction: The erector spinae plane block (ESPB) has been described as an effective analgesic modality in the emergency department (ED) for thoracic pain. It has not previously been described to treat ED patients with pain in the upper extremity. Case Report: We present a case of a 52-year-old female who presented to the ED with an acute exacerbation of her chronic radicular left arm pain originating after a fall she sustained one year prior. After a variety of analgesic modalities failed to control her pain, an ESPB was used to successfully treat her pain and facilitate discharge from the ED. Conclusion: A significant portion of patients who present to the ED have underlying chronic pain; however, opioids are a potentially dangerous and ineffective modality to treat chronic pain. In addition to avoiding opiates, the ESPB has the advantage of preserving motor function, thus avoiding the complications associated with brachial plexus blockade.

Perineural Epinephrine for Brachial Plexus Block Increases the Incidence of Hypotension during Dexmedetomidine Infusion: A Single-Center, Randomized, Controlled Trial

Background: Sedation using dexmedetomidine is frequently associated with hypotension. In contrast, epinephrine, a commonly used adjunctive agent in regional anesthesia, is a potent vasopressor. We hypothesized that perineural epinephrine used in brachial plexus blockade may reduce hypotension during dexmedetomidine infusion. Methods: Patients scheduled for upper extremity surgery were randomly allocated into a control and an epinephrine group. All patients received brachial plexus blockade, consisting of 25 mL of a 1:1 mixture of 1% lidocaine and 0.75% ropivacaine, with patients in the epinephrine group also receiving 125 μg epinephrine. Intraoperative sedation was induced using dexmedetomidine at a loading dose of 1 µg/kg and maintenance dose of 0.4 µg/kg/hr. The primary outcome was the incidence of intraoperative hypotension or hypotension in the post-anesthesia care unit (PACU). Results: One hundred and thirty patients were included (65 per group). The incidence of hypotension was significantly higher in the epinephrine than in the control group (80.6% vs. 56.9%, p = 0.009). The duration of hypotension and the maximal change in blood pressure were also greater in the epinephrine group. Conclusions: Perineural epinephrine for brachial plexus blockade does not reduce hypotension due to dexmedetomidine infusion and may actually augment the occurrence of hypotensive events.

Anaesthetic Efficacy of Nalbuphine as an Adjuvant to Ropivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Blockade: ARandomised Controlled Trial

Introduction: Ultrasonography (USG) guided supraclavicular block is an excellent choice for upper limb surgeries. It not only allows smaller volumes of local anaesthetic usage but also provides optimal tourniquet coverage. Ropivacaine is structurally related to bupivacaine with reduced potential for toxicity and improved sensory and motor blocking profiles. Nalbuphine acquired a significant place in pain control but its efficacy as a local anaesthetic adjuvant is yet to be proved in peripheral nerve blockades. Aim: To evaluate the efficacy of adding nalbuphine to ropivacaine in supraclavicular brachial plexus blockade and to assess the quality of block for patients undergoing ambulatory forearm and hand surgeries. Materials and Methods: Seventy American Society of Anesthesiologists (ASA) grade 1 and 2 patients were randomised into two groups of 35 each. Group A (n=35): received 24 mL of 0.5% of ropivacaine + 1 mL of nalbuphine (10 mg) and Group B (n=35): received 24 mL of 0.5% of ropivacaine + 1 mL of normal saline. The parameters observed were duration of analgesia, onset of sensory and motor blockade, duration of motor blockade and haemodynamic changes during the procedure. Categorical variables were analysed using the Pearson’s Chi‑square test. Continuous variables were analysed using the independent sample t‑test and p<0.05 was considered as statistically significant. Results: The onset of sensory and motor blockades were faster in the nalbuphine group compared to the control group (p<0.001). The duration of sensory and motor blockades was similarly longer in nalbuphine group (p<0.001). Also, the mean duration of analgesia was significantly longer with nalbuphine group (p<0.001). Conclusion: Nalbuphine significantly prolonged the duration of analgesia and duration of block while accelerating the onset of blockade thereby improving the overall quality of blockade.

Study of Comparison of Dexmedetomidine Added to Levobupivacaine versus Alone Levobupivacaine in Supraclavicular Brachial Plexus Blockade

Background: The aim is the current research is the comparison of Dexmedetomidine added to Levobupivacaine versus alone Levobupivacaine in supraclavicular brachial plexus blockade. Subjects and Methods : The current research was performed in the Department of Aneshtesia, Gov- ernment Medical College and SSG Hospital, Vadodara, from October 2014tooctober to 2015. Subjects were separated into 2 groups: Group LD: receives Inj. Levobupivacaine 0.5 %(35ml)+inj.Dexmedetomidine (0.5 l)+Inj.NS(0.5ml)=total 36 ml. Group L: receives Inj.Levobupivacaine0.5 %( 35ml) + inj. Normal saline(1ml) = 36 ml. Pulse rate, Blood pressure, Respiratory rate and Oxygen saturation (SpO2), Ramsay sedation score were monitored before giving the block, immediately after giving the block, each 5 minutes till fifteen minutes, every fifteen minutes thereafter for one hour and each thirty minutes afterward until the conclusion of surgery. Results: Total duration of sensory block was significantly extended in group LD as a contrast to group L. Total duration of motor block was significantly longer in group LD as a contrast to group L. Patients receiving Dexmedetomidine had long-lasting postoperative analgesia as compared to the control group. Thus, the total duration of analgesia was considerably extended in group LD patients as a contrast to group L patients and the dissimilarity was statistically highly significant. Conclusion: Dexmedetomidine can be utilized as a secure and useful aid to local anesthetics in supraclavicular brachial plexus block to give outstanding perioperative analgesia with negligible consequences.