-
Ugeskrift For Laeger Sep 2022The use of peripheral nerve blocks carries a small risk of most often temporary direct damage to the peripheral nerves. Due to lack of research and differing opinions... (Review)
Review
The use of peripheral nerve blocks carries a small risk of most often temporary direct damage to the peripheral nerves. Due to lack of research and differing opinions regarding the potential of nerve blocks delaying the diagnosis of acute compartment syndrome, there is currently no consensus between anaesthetic- and orthopaedic associations regarding the use of peripheral nerve blocks in patients at risk of acute compartment syndrome. More interdisciplinary research is needed to inform and promote an evidence-based discussion of the subject, as argued in this review.
Topics: Anesthesia, Conduction; Compartment Syndromes; Humans; Nerve Block; Peripheral Nerves
PubMed: 36205160
DOI: No ID Found -
Anaesthesia Mar 2020
Topics: Anesthesia, Conduction; Anesthesiology; Humans; Nerve Block; Pain Management; Ultrasonography, Interventional
PubMed: 31268173
DOI: 10.1111/anae.14768 -
Journal of Clinical Anesthesia Dec 2016Peripheral nerve blocks (PNBs) are increasingly used as a component of multimodal analgesia and may be administered as a single injection (sPNB) or continuous infusion... (Review)
Review
Peripheral nerve blocks (PNBs) are increasingly used as a component of multimodal analgesia and may be administered as a single injection (sPNB) or continuous infusion via a perineural catheter (cPNB). We undertook a qualitative review focusing on sPNB and cPNB with regard to benefits, risks, and opportunities for optimizing patient care. Meta-analyses of randomized controlled trials have shown superior pain control and reductions in opioid consumption in patients receiving PNB compared with those receiving intravenous opioids in a variety of upper and lower extremity surgical procedures. cPNB has also been associated with a reduction in time to discharge readiness compared with sPNB. Risks of PNB, regardless of technique or block location, include vascular puncture and bleeding, nerve damage, and local anesthetic systemic toxicity. Site-specific complications include quadriceps weakness in patients receiving femoral nerve block, and pleural puncture or neuraxial blockade in patients receiving interscalene block. The major limitation of sPNB is the short (12-24 hours) duration of action. cPNB may be complicated by catheter obstruction, migration, and leakage of local anesthetic as well as accidental removal of catheters. Potential infectious complications of catheters, although rare, include local inflammation and infection. Other considerations for ambulatory cPNB include appropriate patient selection, education, and need for 24/7 availability of a health care provider to address any complications. The ideal PNB technique would have a duration of action that is sufficiently long to address the most intense period of postsurgical pain; should be associated with minimal risk of infection, neurologic complications, bleeding, and local anesthetic systemic toxicity; and should be easy to perform, convenient for patients, and easy to manage in the postoperative period.
Topics: Humans; Nerve Block; Pain, Postoperative; Peripheral Nerves
PubMed: 27871587
DOI: 10.1016/j.jclinane.2016.08.041 -
Medicine Jul 2022Caudal and dorsal penile nerve blocks are commonly used regional anesthesia methods in hypospadias surgery. Some studies have reported that regional anesthesia methods...
Caudal and dorsal penile nerve blocks are commonly used regional anesthesia methods in hypospadias surgery. Some studies have reported that regional anesthesia methods are risk factor for the development of postoperative complications following hypospadias surgery. The aim of the current study is to evaluate the relationship between postoperative complications and regional anesthesia methods used in distal hypospadias surgery. Forty-nine distal hypospadias patients were included. Patients had either received caudal or ultrasound (US)-guided dorsal penile nerve block. The age, type of hypospadias, regional anesthesia method, operation time, and postoperative complications were recorded. Fisher exact test and Mann-Whitney U tests were used to compare the data. Caudal epidural block was used in 25 (51%) patients and US-guided dorsal penile nerve block in 24 (49%) patients. There was no statistically significant difference between the groups regarding the types of hypospadias, operation time, and age. Fistula developed in 4 (16%) patients in the caudal block group and in none of the patients in the dorsal penile nerve block group. Fistula rates were statistically significantly different between the groups (P = .030). Conflicting data are found in the literature on the long-term postoperative complications of the regional anesthesia techniques used in hypospadias surgery. In our study, all patients with urethrocutaneous fistula were in the caudal block group. We believe that our study will contribute to the literature as it is the only study comparing caudal block with US-guided dorsal penile nerve block using in-plane technique in terms of postoperative complications in hypospadias surgery.
Topics: Humans; Hypospadias; Male; Nerve Block; Postoperative Complications; Pudendal Nerve; Retrospective Studies; Ultrasonography, Interventional
PubMed: 35777019
DOI: 10.1097/MD.0000000000029700 -
Revista Brasileira de Anestesiologia 2012Shoulder pain is a frequent complaint that results in great functional disability in the affected shoulder as well as the decrease in patients' quality of life.... (Review)
Review
BACKGROUND AND OBJECTIVES
Shoulder pain is a frequent complaint that results in great functional disability in the affected shoulder as well as the decrease in patients' quality of life. Suprascapular nerve block is an effective therapeutic method and has been increasingly used by anesthesiologists both for regional anesthesia and postoperative analgesia of surgeries carried out in this articulation, which justifies this review, whose main purpose was to describe the applied technique and clinical indications.
CONTENT
It is presented the anatomy of suprascapular nerve, since its brachial plexus origin until its terminal branches, as well as general characteristics and technique employed to carry out the block of this nerve, main drugs used, volume and situations that give rise to its applications.
CONCLUSIONS
Suprascapular nerve block is a safe and extremely effective procedure in shoulder pain therapy. It also has an easy reproducibility and has been very used by professionals of many medical specialties. When it is well-indicated, this method must be taken into consideration.
Topics: Brachial Plexus; Humans; Nerve Block; Shoulder Pain
PubMed: 22248771
DOI: 10.1016/S0034-7094(12)70108-3 -
Anaesthesiology Intensive Therapy 2015Axillary brachial plexus block is one of the most popular and widely used approaches for brachial plexus blocks. Its main advantages are its versatility and high safety.... (Review)
Review
Axillary brachial plexus block is one of the most popular and widely used approaches for brachial plexus blocks. Its main advantages are its versatility and high safety. Brachial block facilitates analgesia for the distal arm, elbow, forearm and hand. Numerous upper limb procedures, particularly orthopedic ones, can be carried out under axillary block. Axillary block is well suited for the ultrasound-guided technique. Because the brachial plexus in the axillary region is located superficially, the nerves, block needle, and local anesthetic spread are all relatively easy to visualize. A high-frequency linear probe can be used during block procedure, so the quality and resolution of the ultrasound images are excellent. An important feature of the axillary approach is its high level of safety. In the axillary area, there are no anatomical structures other than vessels, to which damage during block placement could pose a risk for the patient. For this reason, axillary block is one of the techniques that are recommended for learning ultrasound-guided regional anesthesia. This paper summarizes anatomical fundamentals and provides basic sonoanatomic knowledge that is essential for successful ultrasound-guided axillary block.
Topics: Brachial Plexus; Humans; Nerve Block; Peripheral Nerves; Ultrasonography, Interventional
PubMed: 26401746
DOI: 10.5603/AIT.2015.0052 -
British Journal of Anaesthesia Oct 2018
Topics: Analgesics, Opioid; Anesthetics; Emergency Medical Services; Humans; Nerve Block; Patient Safety
PubMed: 30236262
DOI: 10.1016/j.bja.2018.04.029 -
Minerva Anestesiologica Sep 2019The performance of a precise and safe peripheral nerve blockade (PNB) can currently rely on the aid of the ultrasounds and nerve stimulators. The injection pressure... (Review)
Review
The performance of a precise and safe peripheral nerve blockade (PNB) can currently rely on the aid of the ultrasounds and nerve stimulators. The injection pressure monitoring may be beneficial to perform a safer procedure. This review focuses on the pressures measured during PNB among studies conducted on animal, and human models. From a deep research among the PubMed/MEDLINE database for all reports published in English between January 2004 and November 2018, we selected 15 original papers. We excluded those that were reviews, case-reports, recommendations and correspondences, that did not match with object of our study. We highlighted the available systems for monitoring injection pressures and classified the reports on the basis of the model used for the respective study (animals, humans, in vitro). Intraneural injections were associated with lower pressures than perineural ones. High injection pressures registered at the needle tip were associated with an increased risk of nerve damage. To date, a precise cut-off pressure value has not yet emerged from the literature for a safe PNBs, but based on the recent literature, it can be stated that the threshold of 15 psi is an acceptable value under which a perineural injection can be performed during a PNB to achieve a safer procedure. So it is desirable to make further studies in order to assess them. In the future, the monitoring of the pressure could allow the use of a minimal quantity of anesthetic, empowering the safety of the nerve blocks. Moreover, the sensitive system should not be invasive and it should not hinder the job of the anesthetists.
Topics: Animals; Cadaver; Humans; In Vitro Techniques; Infusion Pumps; Injections; Intraoperative Complications; Mammals; Manometry; Needles; Nerve Block; Peripheral Nerve Injuries; Syringes; Ultrasonography, Interventional
PubMed: 31124620
DOI: 10.23736/S0375-9393.19.13518-3 -
Minerva Anestesiologica Oct 2009Pediatric regional anesthesia has attained wide use internationally because of its efficacy and safety; its use is supported by the existence of extensive data from the... (Review)
Review
Pediatric regional anesthesia has attained wide use internationally because of its efficacy and safety; its use is supported by the existence of extensive data from the international literature underlining the safety and efficacy of this technique. Safer drugs and dedicated pediatric tools are the keys to this success. Indeed, if we compare the drugs available to pediatric anesthesiologists for use in performing a block years ago with those in use today, it can be seen that progress in this area has been tremendous. The long journey began many years ago; at that time, pediatric regional anesthesia was seen as an extravagant and useless technique, used by only a few and opposed by many detractors. Despite its well-known benefits, clinical failures can occur during the application of regional anesthetic techniques. Neurovascular anatomy is highly variable, and presently available nerve localization techniques provide little or no information regarding the anatomical spread of local anesthesia; furthermore, traditional nerve localization techniques (nerve stimulation) rely on anatomical assumptions that may be incorrect. Modern imaging techniques, such as computed tomography scanning and ultrasound, are now available for improving these procedures. The ultrasound technique is now widely applied in children and many reports confirm the efficacy and advantages of this method. In children, ultrasound guidance has been shown to improve block characteristics, resulting in shorter block performance time, higher success rates, shorter onset, longer block duration, reduction in volume of local anesthetic agents required, and better visibility of neuraxial structures. Clinical studies in children suggest that ultrasound guidance has some advantages for regional block over more traditional nerve stimulation-based techniques. However, with the exception of ilio-inguinal blocks, the advantage of ultrasound guidance over traditional with respect to safety has not been adequately demonstrated in children, since there are only a limited number of randomized control trials in children comparing ultrasound-guided peripheral nerve block with other techniques. Real-time ultrasound guidance for peripheral regional anesthesia is not a foolproof technique. New data have emerged suggesting that the novice ultrasonographer may often commit repeated errors, the two most common being failure to visualize the needle during advancement and unintentional probe movement. For this reason, the American Society of Regional Anesthesia and the European Society of Regional Anesthesia created a Joint Committee, and a document was produced ''to recommend to members and institutions the scope of practice, the teaching curriculum, and the options for implementing the medical practice of ultrasound-guided regional anesthesia services".
Topics: Anesthesia, Conduction; Child; Humans; Nerve Block
PubMed: 19798014
DOI: No ID Found -
British Journal of Anaesthesia Aug 2008
Topics: Anticoagulants; Device Removal; Evidence-Based Medicine; Humans; Nerve Block; Peripheral Nerves
PubMed: 18614597
DOI: 10.1093/bja/aen192