Brachial Plexus Block Anesthesia Research Articles

Influence of the Type Of Anesthesia On The Rate Of Maturation Of Arteriovenous Fistulas In Patients On Hemodialysis Protocol

This article aims to determine if the type of anesthesia influences the maturation rate of arteriovenous fistulas (AVF) in patients on hemodialysis protocol. To this end, an observational, retrospective study was carried out from the clinical records of patients who underwent AVF in the period December 2021-June 2022 at the ISSSTE Tláhuac Hospital. Information of interest was obtained from the records, including age, sex, anthropometric characteristics, comorbidities, anesthetic risk, type of anesthesia (BPB: brachial plexus block versus general anesthesia), fistula maturation, and complications. Descriptive and inferential statistical analysis was performed. A cutoff value of p ≤0.05 was considered significant. 45 patients with a mean age of 54.8±10.6 years were included. At three weeks post-fistula formation, the AVF maturation rate was 84.4%. At 6 months of follow-up, 97.8% of the fistulas were functional. Steal syndrome was the only complication and was found in 6.7% of patients. The Odds Ratio (OR) for fistula maturation in patients who underwent BPB was 8.1, 95%CI 1.3-48.8 (p=0.023). It can be concluded that the BPB is associated with a higher rate of AVF maturation for hemodialysis.

Rebound pain after arthroscopic cuff repair with interscalene brachial plexus block anesthesia is reduced by surgeon administered multimodal shoulder injections: A prospective randomized controlled trial.

To compare the effects of additional multimodal shoulder injections on postoperative rebound pain in patients undergoing arthroscopic rotator cuff repair (ASRCR) under interscalene brachial plexus block (ISBPB) anesthesia. A single-blind randomized controlled trial was conducted with 67 patients between April 2023 and December 2023. Patients undergoing ASRCR got an ISBPB anesthesia, not general anesthesia, were included with a minimum follow-up period of 48 h. The injection group received 40 mL of 0.75% ropivacaine, 20 mg morphine, 1:200,000 epinephrine, and saline solution, totaling 100 mL. Following surgery, the injection was administered to the subacromial space (50 ml) with blind suprascapular nerve block (25 ml) and blind axillary nerve block (25 ml). Controls received 100 mL of saline solution. Intravenous patient-controlled analgesia (IV-PCA) was used as adjuvant analgesia for all patients. The primary outcome was evaluated using the visual analog scale (VAS) pain score at 12 h after surgery, with secondary outcomes of the incidence of rebound pain and VAS pain scores at 0, 2, 4, 8, 24, 36, and 48 h postoperatively. Fentanyl in IV-PCA and rescue analgesic amounts, complications, and satisfaction were recorded. Sixty-seven patients (32 in the injection group, 35 in the control group) with a mean age of 61.1±9.0 years were included. The primary outcome assessment, VAS pain score at 12 h, significantly favored the injection group (2.7±0.93 vs. 4.1±1.70, p<0.001). The incidence of rebound pain was 18.8% and 65.7% in the injection and control groups, respectively (18.8% vs 65.7%, p<0.001). The injection group reported better VAS pain scores at 24, 36, and 48 h, and lower fentanyl use over the 48 h postoperative period (p=0.014). The use of rescue analgesics was similar between groups and no complications were associated with multimodal shoulder injections. Satisfaction levels were similar in both groups. The present study found that multimodal shoulder injections during ASRCR under ISBPB anesthesia significantly lowered VAS pain scores at 12 hours postoperatively and reduced the incidence of rebound pain compared to the control group. Pain levels were consistently lower from 12 to 48 hours postoperatively. Additionally, the injection group had reduced opioid consumption within the first 48 hours postoperatively, with no complications observed. Level I, randomized controlled trial.

A comparative study on sedative and cardiorespiratory effects of clonidine and dexmedetomidine added to ropivacaine in supraclavicular brachial plexus block in upper extremity surgery

Background: Supraclavicular brachial plexus block is widely used peripheral nerve block technique used for surgery of the upper extremity. Several drugs have been used with local anesthetic as adjuvants for rapid, dense, and prolonged analgesia. Aims and Objectives: The aims and objectives of the study are to compare the degree of sedation and cardiorespiratory effects of clonidine and dexmedetomidine added to ropivacaine in supraclavicular brachial plexus block. Materials and Methods: A double-blinded comparative study was done on eighty patients who were randomly allocated equally into two groups and received clonidine and dexmedetomidine added to ropivacaine 0.5%. Intraoperative degree of sedation and cardiorespiratory parameters were monitored in regular intervals and compared to find difference. Results: Heart rate was consistently lower with dexmedetomidine. Systolic, diastolic, and mean arterial pressures (MAPs) were comparable in both groups at all time points except at 45 min when diastolic and MAP were lower with dexmedetomidine and it was statistically significant. Sedation score in Group D was higher except at 5 min and difference was statistically significant. All patients in both groups were sedated and easily arousable. There was statistically significant difference in peroperative oxygen saturation between the groups although it was clinically not significant. Conclusion: There was more hemodynamic effect of dexmedetomidine than clonidine but these effects can be managed by medication easily. In addition to this, it was found that dexmedetomidine provides conscious sedation without any respiratory depression. Comparing the risk and benefit dexmedetomidine can be used with local anesthetic in supraclavicular brachial plexus block in upper extremity surgery.

Effect Analysis of Ropivacaine Combined with Dezocine in Brachial Plexus Block Anesthesia

Effect Analysis of Ropivacaine Combined with Dezocine in Brachial Plexus Block Anesthesia

Comparative Study of General Anesthesia and Regional Anesthesia in Upper Extremity Surgery: Anesthesia Time and Postoperative Hospital Day – A Retrospective Observation Study

Introduction: This study aims to investigate the differences in anesthetic time and hospital stay after surgery based on the anesthesia techniques used in upper extremity surgeries. Methods: A retrospective analysis was conducted on the medical records of 453 patients who underwent upper extremity surgery from January 1, 2020 to March 31, 2022. The patients were divided into two groups: axillary brachial plexus block (BPB) and General Anesthesia (GA). Results: The induction time before starting the operation for axillary BPB was significantly longer than GA. However, the time required to awaken patients from GA was significantly longer than that for patients receiving axillary BPB. Patients who received axillary BPB exhibited significantly shorter stays in the post-anesthesia care unit (PACU) and a reduced time until discharge after surgery (P &lt; 0.05). Conclusion: In upper extremity surgery, axillary BPB requires more induction time than GA. However, axillary BPB demonstrated advantages such as quicker awakening, shorter PACU stays, and reduced hospitalization days after surgery.

Effect of Dexamethasone Addition to Local Anesthetics in Supraclavicular Brachial Plexus Block

Background: The addition of dexamethasone to local anesthetics in supraclavicular brachial plexus block has been studied to evaluate its impact on block onset and duration, potentially enhancing the efficacy of regional anesthesia.&#x0D; Objective: In this study our main goal is to evaluate the effect of dexamethasone added to local anaesthetics on the onset and duration of supraclavicular brachial plexus block.&#x0D; Methods: This cross-sectional study was carried out at tertiary hospital from January 2022 to January 2023. Where 100 adult patients undergoing various orthopaedic surgeries on forearm and around the elbow under supraclavicular brachial plexus block were selected and divided into 2 groups of 50 each. In group-A patients received 35 ml of mixture of lignocaine 2%, bupivacaine 0.5% while in group-B patients received the same amount of local anaesthetics with dexamethasone (8 mg). The onset of sensory and motor block and duration of analgesia in two groups were compared and development of complications were observed.&#x0D; Results: Both Group A (48%) and Group B (42%), where most of the patients in the research are located, have a median age of 41 years. There were 80% males and 20% females in Group A. There were ninety males and ten females in Group B. There was a statistically significant (p 0.05) early onset of sensory and motor block in group B. The analgesic effect lasted much longer in group B (p 0.001) than in group A. In addition, 45% of group A participants were diagnosed with Horner's syndrome, and 7% had Dyspnoea or chest pain. The recurrent laryngeal nerve was blocked in 3% of patients, whereas 2% had insufficient occlusion. In group B, 31% of people experienced horners syndrome, and 5% had Dyspnoea or chest pain. Two percent of patients had a block of the recurrent laryngeal nerve, with one percent experiencing an inadequate block.&#x0D; Conclusion: Addition of dexamethasone to 1.5% lidocaine with adrenaline in supraclavicular brachial plexus block speeds the onset and prolongs the duration of sensory and motor blockade. However, the use of dexamethasone to prolong the effects of local anesthetics is not encouraged. It might be useful in situations when epinephrine use is limited (such as in hypertension or cardiovascular disease).

The recovery of upper limb function and postoperative pain in children with lateral humeral condyle fractures were examined retrospectively in relation to the effects of brachial plexus block given in conjunction with general anesthesia

ObjectiveTo assess in retrospect the effects of brachial plexus block and general anesthesia on children with lateral humeral condyle fractures in terms of postoperative pain and return of upper limb function.MethodsRandomly allocated to either the control group (n = 51) or the study group (n = 55) were children with lateral humeral condyle fractures who were admitted to our hospital between October 2020 and October 2021, depending on the surgical anesthetic technique used. The research group had internal fixation surgery with brachial plexus block in addition to anesthesia on the basis of the control group, whereas both groups of children underwent the procedure with general anesthesia alone. Postoperative pain degree, upper extremity functional recovery, occurrence of adverse reactions, etc.ResultsThe study group had shorter mean times for surgery, anesthesia, propofol dose, return to consciousness, and extubation than the control group did at every measure of statistical significance. The T2 heart rate (HR) and mean arterial pressure (MAP) were both significantly lower than the pre-anesthesia HR and MAP, and the T1, T2, and T3 HR and MAP were all significantly lower in the study group compared to the control group (P < 0.05). The difference between the SpO2 values at T0 and T3 was not statistically significant (P > 0.05); the VAS scores at 4 h, 12 h, and 48 h after surgery were higher than those at 2 h after surgery, and reached the peak at 4 h after surgery; within 2 h, 4 h, and 12 h of surgery At 48 h, the study group had substantially lower VAS ratings than the control group (P < 0.05). Post-treatment Fugl–Meyer scale scores were considerably higher across the board compared to pre-treatment levels in both groups. When compared to the control group, individuals who participated in the flexion-stretching coordinated exercise and the separation exercise had significantly better ratings. Electrocardiogram, blood pressure, respiratory circulation, and hemodynamic parameters all remained within normal limits during the surgical procedure. The study group had a 9.09% reduced incidence of adverse events compared to the control group. 19.61% (P < 0.05).ConclusionWhen used in conjunction with general anesthesia, brachial plexus block can help children with lateral humeral condyle fractures regulate perioperative signs, maintain their hemodynamic level, lessen postoperative pain and unpleasant reactions, and improve the function of their upper limbs. Functional recovery, with high safety and effectiveness.

Retracted: Efficacy of Dexamethasone versus Dexmedetomidine Combined with Local Anaesthetics in Brachial Plexus Block: A Meta-Analysis and Systematic Review.

[This retracts the article DOI: 10.1155/2022/7996754.].

Comparative study between bupivacaine 0.5% vs. bupivacaine 0.5% plus lidocaine 2% vs. lidocaine 1.5% in ultrasound guided axillary brachial plexus block for brachiocephalic fistula formation in chronic renal failure patients

Abstract&#x0D; Background: Patients with chronic renal insufficiency need to have arteriovenous fistula (AVF) for hemodialysis.Ultrasound guided axillary brachial plexus block is a good substitute to general anesthesia or local anesthesia as it causes vasodilatation and minimum hemodynamic derangement, besides offering prolonged postoperative analgesia. We compared three types of local anesthetic solutions; bupivacaine 0.5%, bupivacaine 0.5% plus lidocaine2% and lidocaine 1.5% for onset and duration when used for axillary brachial plexus block.&#x0D; Methodology: Sixty-six patients were randomly allocated to one of the three different groups: Group B: patients received 30 ml of bupivacaine 0.5% for the block; Group BL: received 15 ml of bupivacaine 0.5% with 15 ml lidocaine 2% and Group L: received 30 ml of lidocaine 1.5% for the block under US guidance. Onset of sensory and motor anesthesia were registered, and the time to first analgesic demand postoperatively was noted. Statistical analysis of the results was undertaken.&#x0D; Results: Results showed that regarding the onset of sensory anesthesia, lidocaine group had the shortest time and the results were statistically significant compared to the other two groups. A statistically non-significant difference was found between Group B and Group BL, where Group BL had shorter time of onset than Group B, e.g., 9.05 ± 1.36 vs. 9.77 ± 0.97 min. The onset of motor block was the earliest in Group BL and the result was considered nonsignificant between Group L and Group B being shorter in Group L; the difference in results was also non-significant between Group BL and Group L. Significantly longer duration of motor and sensory blocks was noted in Group B and compared to the BL and L groups. As regards the timing of first analgesic need, there was statistically significant difference between all groups being longest in Group B (608.68 ± 21.74 min)&#x0D; Conclusion: This study revealed that using 30 ml of bupivacaine 0.5% in axillary brachial plexus block with ultrasound guidance in ESRD patients for AVF creation gives much better results than 30 ml of lidocaine 1.5% or a mixture of Abdelhady ISM, et al local anesthetics for axillary brachial plexus block www.apicareonline.com 744 Open access attribution (CC BY-NC 4.0) bupivacaine 0.5% with lidocaine 2% as regards to onset of anesthesia, postoperative analgesia and patient satisfaction.&#x0D; Trial Registry: PACTR202208582938205&#x0D; Abbreviations: AVF: arteriovenous fistula; BPB: Brachial plexus block; ESRD: End stage renal disease; GA: General anesthesia; NRS: Numeric rating scale; RA: Regional anesthesia&#x0D; Key words: Bupivacaine; Lidocaine; Hemodialysis; Brachial plexus block&#x0D; Citation: Abdelhady ISM, Ghallab MAA, Zaki MSM, Abdelrahman KAS, Soliman AFH. Comparative study between bupivacaine 0.5% vs. bupivacaine 0.5% plus lidocaine 2% vs. lidocaine 1.5% in ultrasound guided axillary brachial plexus block for brachiocephalic fistula formation in chronic renal failure patients. Anaesth. pain intensive care 2022;26(6):743−748; DOI: 10.35975/apic.v26i6.2055&#x0D; Received: September 14, 2022; Reviewed: October 28, 2022; Accepted: October 31, 2022&#x0D;

Effect of Addition of Dexamethasone to Local Anaesthetics in Supraclavicular Brachial Plexus Block

Background: In many cases, local anesthesia may be just as effective as general. The regional embargo has been maintained with the use of several additives. Objective: In this study our main goal is to evaluate the effect of dexamethasone added to local anaesthetics on the onset and duration of supraclavicular brachial plexus block. Method: This cross sectional study was carried out at tertiary hospital from January 2021 to January 2022. Where 100 adult patients undergoing various orthopaedic surgeries on forearm and around the elbow under supraclavicular brachial plexus block were selected and divided into 2 groups of 50 each. In group-A patients received 35 ml of mixture of lignocaine 2%, bupivacaine 0.5% while in group-B patients received the same amount of local anaesthetics with dexamethasone (8 mg). The onset of sensory and motor block and duration of analgesia in two groups were compared and development of complications was observed. Results: During the study most of the patients belong to 41-50 years age group for both Group A (48%) and group B (42%). Group A 80% were male and 20% were female. In Group B 90% and 10% were male and female respectively. Onset of sensory as well as motor blocks were early in group B and was statistically significant (p&lt;0.05) too. Duration of analgesia was markedly prolonged in group B and was statistically highly significant (p&lt; 0.001). Plus in group A horners syndrome cases were 45% followed by 7% had Dyspnoea or chest discomfort 3% had Recurrent laryngeal nerve block and 2% had Inadequate block. Whereas in group B horners syndrome cases were 31% followed by 5% had Dyspnoea or chest discomfort 2% had recurrent laryngeal nerve block and 1% had inadequate block. Conclusion: Dexamethasone is not recommended for use in extending the effects of local anesthetics. It might be helpful in conditions where epinephrine usage is restricted (such as high blood pressure or heart disease).

A meta-analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper-limb orthopaedic trauma surgery.

The adjuvant effectiveness of nalbuphine in context of brachial plexus block (BPB) in patients undergoing upper-limb orthopaedic trauma surgery has remained uncertain. The purpose of this meta-analysis was to evaluate the analgesic benefit of mixing nalbuphine into local anaesthetics in BPB for wound pain from upper-limb trauma surgery. Primary outcome was the duration of analgesia. Seventeen trials (1104 patients) were analysed. Patients receiving nalbuphine have an increased weighted mean difference (WMD) 95% confidence interval of the duration of analgesia by 186.91 minutes (133.67 to 240.16) (P <0.001). Compared to placebo, nalbuphine shorten the onset time of sensory and motor block by WMD of 2.59 (1.27 to 3.92) and 3.06 minutes (1.65 to 4.48) (P <0.001), respectively. Meanwhile, nalbuphine prolonged the durations of sensory and motor block (P <0.001). Qualitative and quantitative synthesis revealed no differences with regard to the outcomes related to side-effects. There is moderate-quality evidence that the addition of nalbuphine to local anaesthetics for BPB in patients undergoing upper-limb orthopaedic trauma surgery significantly prolongs the duration of analgesia, while preserving a similar safety-profile compared with local anaesthetics alone. However, these benefits should be further weighed against nalbuphine-related neurological safety in future studies.

Comparing Preoperative Anxiety Effects of Brachial Plexus Block and General Anesthesia for Orthopedic Upper-Extremity Surgery: A Randomized, Controlled Trial.

Background and objectives: Preoperative anxiety is an enormous feeling of fear that is seen in all patients undergoing surgery. The severity of anxiety may vary depending on the type of surgery and anesthesia to be performed. The aim of this study is to compare the effects of brachial plexus blocks and general anesthesia methods on preoperative anxiety levels in patients who will undergo orthopedic upper-extremity surgery and to determine the factors affecting anxiety. Materials and Methods: After randomization, the Amsterdam Preoperative Anxiety and Knowledge Scale (APAIS) questionnaire was applied to the patients to determine the preoperative anxiety level, and then anesthesia was applied according to the anesthesia type determined. Pain scores (1, 8, 16, and 24 h) and total opioid consumption of the patients were recorded postoperatively. Results: The APAIS score of the patients in the general anesthesia (GA) group was significantly higher (p = 0.021). VAS score medians at 1, 4, and 8 h postoperatively were found to be significantly higher in the GA group (p < 0.001, p < 0.001 and p = 0.044, respectively). Conclusions: USG-guided BPB may cause less anxiety than GA in patients who will undergo elective upper-extremity surgery. However, these patients have moderate anxiety, although it is more associated with advanced age, female gender, and education level.

General versus Brachial Plexus Block Anesthesia in Pain Management after Internal Fixation in Patients with Distal Radius Fracture: A Randomized Controlled Trial.

Distal radius fractures (DRFs) are very common injuries associated with aging, and the number of fractures is increasing with the increase in the elderly population. General anesthesia or brachial plexus block (BPB) is required for fracture fixation, and acute postoperative pain control is necessary after operation. Early pain control can improve patient satisfaction and functional outcomes. In this study, we report the clinical differences in postoperative pain, according to the method of anesthesia (general anesthesia versus brachial plexus block). Volar plating was used to treat 72 patients older than 60 years who had comminuted DRF. Patients were randomized to either group A (36 patients), who underwent general anesthesia, or group B (36 patients), who underwent BPB. We compared these two groups prospectively for acute postoperative pain using a visual analog scale (VAS) at 2, 4, 6, 12, and 24 h after surgery. The VAS scores of each group were: 6.8 ± 2.5 in general anesthesia and 0.5 ± 2.3 in BPB at 2 h, postoperatively; 6.5 ± 2.4 in general anesthesia and 0.5 ± 2.4 in BPB anesthesia at 4 h, postoperatively; 5.2 ± 2.4 in general anesthesia and 1.5 ± 2.4 in BPB anesthesia at 6 h, postoperatively; 4.5 ± 2.5 in general anesthesia and 3.4 ± 2.7 in BPB anesthesia at 12 h, postoperatively; and 3.5 ± 2.5 in general anesthesia and 3.2 ± 2.7 in BPB anesthesia at 24 h, postoperatively. DRF patients with BPB anesthesia showed a lower VAS score than those subjected to general anesthesia in early postoperative period. As a result, the effect of BPB anesthesia on acute pain management after surgery was excellent, which resulted in a lower pain score compared with general anesthesia in DRF patients undergoing volar plating.

Brachial plexopathy following shoulder arthroplasty

BackgroundAnatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) are being performed with increasing frequency. While rare, postoperative brachial plexopathy can occur, and its incidence and natural history remain poorly defined. The purpose of this study is to report the epidemiology, patient characteristics, and clinical course of postoperative brachial plexopathies following shoulder arthroplasty. MethodsAll patients undergoing TSA or RSA at a single institution from April 2017 to May 2019 were included. Patients with postoperative brachial plexus sensorimotor deficits were identified based on postoperative physical examination, imaging, and/or electrodiagnostic data. Patient data including age, body mass index (BMI), medical comorbidities, surgery performed, surgical indications, sensorimotor deficits, and date of onset and resolution of sensorimotor deficits were recorded. ResultsTwelve of 881 patients (1.4%; 8 female, 4 male) who underwent shoulder arthroplasty during the study period were identified with postoperative brachial plexopathy. The median age was 65 years, and median BMI was 24.4 kg/m2. The index procedure included 8 anatomic TSA and 4 RSA in patients with brachial plexopathy. Surgical indications included glenohumeral arthritis (8 patients), rotator cuff arthropathy (2 patients), avascular necrosis (1 patient), and proximal humerus fracture (1 patient). Nine of 12 patients recovered fully at a mean of 8.2 months, 2 patients had incomplete recovery with persistent sensory symptoms at a mean 12.4-month follow-up, and 1 patient was lost to follow-up at 1.3 months and, thus, recovery status is unknown. Patients who received a combination of general anesthesia and brachial plexus block experienced a higher rate of brachial plexopathy than those who received general anesthesia or brachial plexus block alone. ConclusionsThis institutional registry study provides a descriptive analysis of the patient demographics and course of recovery for patients with postoperative brachial plexopathy following shoulder arthroplasty. For this institutional cohort, patients with brachial plexus deficits had a significantly lower BMI and higher rate of receiving a combination of brachial plexus block and general anesthesia than the institutional registry cohort as a whole.

To compare the hemodynamic changes produced by the drug after the usage of Midazolam as an adjunct to bupivacaine in brachial plexus block

Introduction: Bupivacaine, a local anesthetic, in brachial plexus block produces highly efficient intraoperative anesthesia and also analgesia. This study was carried out to observe the effect of the addition of midazolam to local anesthetic in brachial plexus block in the intraoperative and post-operative period. Objective: To compare intraoperative and post-operative Hemodynamic changes (pulse rate, systolic blood pressure, diastolic blood pressure, respiratory rate) with bupivacaine alone and bupivacaine-midazolam combination. Methodology: A randomized clinical trial was conducted on 70 ASA-I or II adult patients undergoing upper limb surgeries (scheduled for forearm and hand surgery) under axillary brachial plexus block. Patients were randomly allocated into two groups of 35 each. Patients in group A were administered 30 ml of 0.5% bupivacaine and those in group B were given 30 ml of 0.5% bupivacaine with midazolam 50 µg·kg–1. Results: The mean (±SD) age of patients in Group A and B were 37.97± 13.73 years and 39.28± 14.19 years respectively. Hemodynamic variables (pulse rate, systolic blood pressure, diastolic blood pressure, respiratory rate) were recorded and compared using the student’s test (paired for intragroup and unpaired for intergroup comparison) and Chi-Square test. P-value &lt;0.05 was taken to be statistically significant and &lt;0.001 highly significant.

General anesthesia versus ultrasound-guided axillary block for ambulatory hand surgery: randomized prospective study

BackgroundIn upper limb surgery, both axillary brachial plexus block (ABPB) and general anesthesia (GA) have been widely used. ABPB is one of the most popular and widely used procedures for brachial plexus blocks, as well as for achieving upper limb regional anesthesia.The aim of the study was to compare between both anesthetic techniques for ambulatory hand surgery regarding their effects on postoperative pain as primary outcome and postoperative nausea and vomiting and patient satisfaction and postoperative sleep disturbances as secondary outcomes.ResultsWe reviewed data from 40 patients for the primary outcome and found that group A (had general anesthesia) had a statistically significant higher postoperative VAS score than group B (got ultrasound guided axillary block), (P-value 0.05). In terms of secondary outcomes, postoperative nausea and vomiting were significantly higher in group A patients (P-value 0.001), and patient satisfaction was significantly higher in group B patients compared to group A patients (P-value 0.001). Furthermore, the Pittsburgh quality index (PSQI) for postoperative sleep disruptions was considerably higher in group A than in group B at 24 h postoperatively and at the first and second weeks postoperatively (P-value 0.001). Statistically, there is no difference between the two groups in the third week and one month after surgery.ConclusionsWhen compared to general anesthesia, ultrasound-guided axillary brachial plexus block offered good anesthesia, great analgesia, and a better postoperative sleep result after hand surgery.

Comparison of infraclavicular brachial plexus block versus wide-awake local anesthesia no-tourniquet technique in the management of radial shortening osteotomy.

Objectives The aim of this study was to evaluate the feasibility of the wide-awake local anesthesia no-tourniquet (WALANT) technique in radial shortening osteotomy and to compare it with the infraclavicular brachial plexus block (IBPB).Patients and methods Between January 2020 and January 2021, a total of 26 patients (16 males, 10 females, mean age: 40±4.9 years; range, 29 to 45 years) with Kienbock’s disease who underwent radial shortening osteotomy were retrospectively analyzed. The patients were divided into two groups according to the type of anesthesia as WALANT (Group 1, n=11) and IBPB (Group 2, n=15) anesthesia. Visual Analog Scale (VAS) during surgery, time from anesthesia to surgical incision, surgical time, overall patient satisfaction regarding the anesthesia was assessed. The Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) and handgrip strengths were compared at the final follow-up and short-term outcomes were analyzed.Results Age (p=0.896), sex (p=1.000), and dominant side involvement (p=1.000) were similar between the groups. Waiting time to start surgery in both groups was similar (27 vs. 25 min; p=0.053). Intraoperative VAS-pain scores and the satisfaction from the anesthesia type of both groups were also similar (p=0.546 and p=0.500).Conclusion The WALANT may be another anesthesia technique for radial shortening osteotomy with favorable outcomes. This technique adequately allows the surgeon to perform osteotomy and obtain a stable reduction without undue risk of tourniquet pain and palsy.

Efficacy of Dexamethasone versus Dexmedetomidine Combined with Local Anaesthetics in Brachial Plexus Block: A Meta-Analysis and Systematic Review.

Background Both dexamethasone and dexmedetomidine are commonly used local anaesthetic adjuvants in brachial plexus block to enhance the blocking effect. However, it is unclear which of the two drugs is more effective in a brachial plexus block. This article compares the effects of dexamethasone and dexmedetomidine combined with local anaesthetics in brachial plexus block through meta-analysis, availing information for current practice and future research. Methods We conducted a search of the PubMed, Embase, Cochrane Library, and Web of Science databases to identify studies investigating the effects of dexamethasone and dexmedetomidine combined with local anaesthetics on brachial plexus block. The databases were searched from their inception to October 2021. Clinical randomized controlled trials were included. Two researchers independently conducted literature screening. The Cochrane System Review Manual was adopted for literature quality evaluation, whereas Stata 14.0 software aided in the meta-analysis. The duration of analgesia was the primary outcome indicator; whereas, the secondary outcome indicators included the duration of sensory block and motor block. Results Seven articles were analysed, including 465 patients. Compared to the dexmedetomidine group, the dexamethasone group exhibited longer durations of analgesia (WMD = 111.29, 95% CI: 16.49–206.10, P = 0.021), sensory block (WMD = 173.20, 95% CI: 86.69–259.71, P < 0.0001), and motor block (WMD = 121.03, 95% CI: 12.87–229.20, P = 0.028). Conclusion The present meta-analysis results affirm that dexamethasone is a better local anaesthetic adjuvant in brachial plexus block that enhances the blocking effect. Nevertheless, the existing heterogeneity warrants additional large-scale, multicentre, high-quality randomized controlled trials in the future for further verification and to provide more reliable clinical evidence.

The effect of adding different doses of Magnesium Sulphate to Bupivacaine in the ultrasound-guided supraclavicular brachial plexus block anesthesia.

The effect of adding different doses of Magnesium Sulphate to Bupivacaine in the ultrasound-guided supraclavicular brachial plexus block anesthesia.

The effect of adding different doses of Magnesium Sulphate to Bupivacaine in the ultrasound-guided supraclavicular brachial plexus block anesthesia.

The effect of adding different doses of Magnesium Sulphate to Bupivacaine in the ultrasound-guided supraclavicular brachial plexus block anesthesia.