Brachial Plexus Block In Patient Research Articles

Comparative study on efficacy of ultrasound-guided supraclavicular versus costoclavicular brachial plexus block in patients for arteriovenous fistula surgery

Background: Patients with end-stage renal failure (ESRF) who require arteriovenous fistula (AVF) creation often have multiple comorbidities, making the brachial plexus block a suitable choice for anaesthesia. The objective of this study is to compare the efficacy of ultrasound-guided supraclavicular and costoclavicular brachial plexus blocks for AVF creation. Methods: A total of 70 patients scheduled for the creation of AVF in the distal upper extremity were randomly assigned to 2 groups: supraclavicular block (SCB), Group A: n = 35, and costoclavicular block (CCB), Group B: n = 35. Both groups received 20 ml of 0.5% ropivacaine and 10 ml of 1% lidocaine. The measured parameters included the speed of onset of motor and sensory blockade, the quality of blockade, procedural-related pain score, patient satisfaction, and regional perfusion. Results: The costoclavicular block demonstrated a significantly faster onset to achieve complete paralysis (p = 0.01) in all sensory and motor nerves compared to the supraclavicular block. Additionally, there was a significant difference in regional perfusion, with higher perfusion observed in the supraclavicular block (p = 0.013). However, there were no significant differences in the quality of block (p = 0.573), and procedural-related pain score (p = 0.117) between the 2 groups. Conclusion: The costoclavicular block offers a faster onset of sensory and motor blockade compared to the supraclavicular block. However, they are comparable in terms of the quality of the block and procedural-related pain. This new technique can be considered as an alternative for providing anaesthesia in patients with ESRFundergoing AVF creation.

High satisfaction rate and range of motion can be expected in frozen shoulder after awake manipulation with brachial plexus block

BackgroundAdhesive capsulitis (AC) is a disease of the glenohumeral joint that is characterized by pain and both passive and active global stiffness with a slow and insidious onset. The disease can occur spontaneously (primary AC) or it can be secondary to other comorbidities, surgery, or trauma, such as fracture or dislocation. Multiple treatment approaches have been suggested: intra-articular steroid injection, physical therapy, manipulation under total anesthesia, and arthroscopic or open surgery. Shoulder manipulation under anesthesia is usually proposed to patients that suffer from severe AC and have already undergone several nonoperative treatments without benefit. Different techniques have been proposed. This study presents our manipulation technique and the clinical results we achieved after shoulder mobilization under brachial plexus block in patients with phase III primary AC.Materials and methodsA retrospective cohort study was performed on a sample of 110 patients with phase III AC who were treated with this manipulation and followed up for 1 year. Patients underwent two assessments—before the procedure (T0) and 4 months after it (T1)—based on the Numerical Rating Scale, Simple Shoulder Test, and joint range of motion to assess shoulder pain, function, and joint articulation, respectively. Furthermore, the patients had to express their degree of satisfaction with the procedure and the results achieved.ResultsPositive and statistically significant results were recorded in terms of pain reduction (ΔNPRS = − 5.4; p < 0.01) and improved functionality (Simple Shoulder Test Δ = 5; p < 0.01). Passive range of motion was statistically significantly increased for each movement at T1. Large increases were observed in extrarotation range of motion (ROM): R1 (Δ = 77.5°) and R2 (Δ = 70°), whereas little improvements were observed in intrarotation ROM. Patients achieved satisfying functional and articular recovery in all cases. Complications that needed further treatment occurred in three cases: a brachial plexus injury, a glenoid flake fracture, and persistent pain and stiffness.ConclusionsIn this study, we proposed a standardized method of manipulation under brachial plexus block for patients affected by phase III adhesive capsulitis. The technique was applied among a large cohort of patients, who reported a high satisfaction rate and range-of-motion recovery after 4 months. This could represent an alternative treatment to surgery that has a shorter timeline and does not require patient hospitalization.Level of evidence: Level III, retrospective cohort study.

Comparative study between dexmedetomidine and dexamethasone as an adjuvant to levobupivacaine for supraclavicular brachial plexus block in patients undergoing upper limb surgeries

Background: Brachial plexus block (BPB) is widely used nowadays in patients undergoing upper limb surgery. Levobupivacaine is one of the best local anesthetics in the current scenario in this field. Both dexmedetomidine (DM) and dexamethasone (DX) are commonly used local anesthetic adjuvants in BPB to enhance blocking effects. In anesthesiology, there is always a search for a better alternative. Aims and Objectives: In this study, we investigated the effect of DM and DX as adjuvants to levobupivacaine on the quality of supraclavicular BPB. Materials and Methods: A prospective, double-blind, randomized controlled intervention study (superiority trial) was done involving 60 patients aged 20–60 years, randomly allocated into two equal groups (group S-DM group-Patients were received Injection 0.25% Levobupivacaine 2 mg/kg body weight+Inj. DM 1 mcg/kg body weight+distilled water [total volume 30 mL] and group C-DX group-Patients received Inj. 0.25% Levobupivacaine 2 mg/kg+Inj. DX 0.1 mg/kg body weight+Distilled water [total volume 30 mL]). The scores of the modified Gormley and Hill scale and the modified Bromage scale were recorded along with hemodynamic parameters. Pearson’s Chi-square test, Mann-Whitney U-test, one-way ANOVA, Kaplan–Meier survival analysis, and Z-test were used for statistical analysis. Results: The onset of motor block was shorter in group-S patients (14.2667±1.0807 [min]) compared to group-C (15.9333±1.5742 [min]), and the duration of motor block was higher in group-S (708.5667±4.2644 [min]) compared to group-C patients (682.3667±20.0095 [min]) (P&lt;0.001). Conclusion: DM is a better alternative to DX when added to levobupivacaine for decreasing the onset of sensory and motor block and increasing the duration of supraclavicular BPB.

COMPARATIVE STUDY OF BUPIVACAINE WITH DEXMEDETOMIDINE AND BUPIVACAINE ALONE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Objective: The objective is to compare the efficacy of bupivacaine with dexmedetomidine and bupivacaine alone when used for supraclavicular brachial plexus block in patients undergoing upper limb surgeries. Methods: This was a comparative study conducted in the department of anesthesiology of a tertiary care medical college. 80 patients scheduled for upper limb surgeries under supraclavicular brachial plexus block were included on the basis of a predefined inclusion and exclusion criteria. Patients were divided into 2 groups depending on whether they received only Bupivacaine (Group B) or Bupivacaine and Dexmedetomidine (Group BD) for supraclavicular block. The onset and duration of sensory as well as motor blockade, intensity of Pain as assessed by Visual Analog Score, requirement of rescue analgesia, hemodynamic profile, and side effects were compared in both the groups. For statistical purpose p&lt;0.05 was taken as statistically significant. Results: Group BD exhibited significantly faster onset and longer duration of sensory blockade compared to Group B. Group BD also showed significantly faster onset and longer duration of motor blockade compared to Group B. Moreover, Group BD had significantly longer analgesia duration (614.84±52.02 min) compared to Group B (352.62±32.46 min). The hemodynamic parameters, including mean heart rate and mean arterial pressure, were not significantly different between the groups. In addition, side effects such as bradycardia and hypotension were observed in Group BD, but these differences were not statistically significant. Conclusion: Dexmedetomidine, when used as an adjuvant to bupivacaine during supraclavicular brachial plexus block in upper limb surgeries provided longer-lasting analgesia, and reduced pain intensity as compared to Bupivacaine alone with a comparable side effect profile.

The Effects of Dexamethasone versus Potassium Chloride as Additives to Local Anesthetic in Supraclavicular Brachial Plexus Block

Abstract Background Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Regional anesthesia of the trunk and the extremities an alternative to general anesthesia in many situations. It avoids the unwanted effects of the anesthetic drugs used during general anesthesia and the stress of laryngoscopy and tracheal intubation. Aim of the Work To compare the clinical efficacy of addition of dexamethasone or potassium chloride to local anesthetic solution of bupivacaine and lignocaine on the onset, duration, quality of analgesia, and quality of sensory and motor blockade in supraclavicular brachial plexus block in patients undergoing upper extremity surgeries. Patients and Methods This study is a prospective double – blinded, randomized trial After obtaining approval from the Research Ethical Committee of faculty of medicine Ain shams University, this study was conducted in the operating theaters of Ain shams University Hospital. Results In the current study, it was obvious that: addition of Dexamethasone to bupivacaine in supraclavicular nerve block shortened the onset times of both sensory and motor blocks than add. Addition of Dexamethasone to bupivacaine significantly prolongs both sensory and motor block durations than injecting dexamethasone intravenously. Addition of Dexamesthasone to bupivacaine prolongs the analgesia of brachial plexus block with subsequent consumption of less amount of analgesics than adding Potassium Chloride. Conclusion 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.

Perioperative respiratory and analgesic effects of ultrasound-guided extrafascial versus interfacial interscalene brachial plexus block in patients undergoing shoulder arthroscopy

Perioperative respiratory and analgesic effects of ultrasound-guided extrafascial versus interfacial interscalene brachial plexus block in patients undergoing shoulder arthroscopy

Comparative Evaluation of Dexmedetomidine and Dexamethasone as Adjuvants in Supraclavicular Brachial Plexus Block.

Introduction Currently, peripheral nerve block has shown immense potential with effective patient satisfaction. In the event of upper limb surgeries, the supraclavicular brachial plexus approach under ultrasound guidance renders quick and dense anesthesia. In addition, the clinical utility of adjuvants with local anesthetics elicits a good quality of nerve block with improved duration and inset. So the aim of the present study was tocompare the block characteristics of dexmedetomidine and dexamethasone during supraclavicular brachial plexus block in patients undergoing upper limb surgeries. Materials and methods The present study was conducted on 100 patients aged 20-60 years with the American Society of Anesthesiologists (ASA)-I and ASA-II classification who were scheduled for upper limb surgeries. These patients were divided equally into two groups, namely group D (who received 20mL of 0.5% bupivacaine + 50 mcg (0.5mL) of dexmedetomidine +1.5mL normal saline) and group X (who received 20mL of 0.5% bupivacaine +8mg of dexamethasone), ensuring a total volume of 22mL administered to both groups. The time of onset and duration of the sensory and motor blocks, as well as the quality of intraoperative analgesia, were assessed. Results The addition of dexmedetomidine (50mcg) and dexamethasone (8mg) to 0.5% bupivacaine ensured a faster onset and prolonged duration of the sensory and motor blocks. Additionally, dexmedetomidine resulted in more prolonged postoperative analgesia, a lower mean visual analogscale score in the first 24 hours, and lesser opioid consumption in 24 hours than dexamethasone. Conclusion Dexmedetomidine is superior to dexamethasone as an adjuvant to bupivacaine during supraclavicular brachial plexus block in patients undergoing upper limb surgeries.

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.

Surgeon-administered intraoperative brachial plexus block for open shoulder surgery - a novel and safe technique.

In the era of outpatient shoulder surgery, bundled payment, safe, predictable, and time-efficient pain management strategies for shoulder arthroplasty (SA) are important. Ultrasound-guided interscalene blocks (ISBs), currently the gold standard for postoperative pain management after shoulder surgery, can be highly operator dependent, time-consuming, and not without complications. We developed a new surgical technique of surgeon-administered intraoperative brachial plexus block in patients undergoing SA open shoulder surgery using the deltopectoral approach. This procedure could be performed after the exposure, either at the beginning or end of the bony work. This procedure is simple, safe, and effective. We did not notice any complications that are typically seen with ISB-like respiratory depression secondary to phrenic nerve palsy, rebound pain after the block wore off, and pain related conversion of outpatient SA to inpatient, over the period of four years (2018-2022). This technique has additional advantages over the established "gold standard" ISB in terms of time and cost savings and improved operating room efficiency.

Supraclavicular Brachial Plexus Block with or without Dexamethasone

Aim: To assess the effect of supraclavicular brachial plexus block in patients with or without dexamethasone. Study design: Double blind randomized controlled trial Place and duration of study: Department of Anesthesia and Critical Care, The Indus Hospital a free of cost tertiary care hospital in Karachi from 9th May 2019 to 19th February 2020. Methodology: Sixty patients were enrolled with 30 patients in each intervention group. Patients who came for elective or emergency surgery of the upper limb below shoulder were included in the study. Block performed on patients lying supine at 45 degree. The dexamethasone group received 0.25% plain bupivacaine 18 ml with 2ml dexamethasone (0.4mg/ml) and control group received 0.25% plain bupivacaine 18 ml with 2 ml normal saline. Results: The age of the group B patients was higher than the group A patients such as 43.4±15.7 years vs 38.6±14.2 years. The ASA level presented higher scoring than II in patients from Group B with 63.3% those patients who called for pain. In this study the intra operative vital signs showed an insignificant variance in both groups.However, a significant increase in duration of analgesia was observed in group A. Conclusion: Perineural administration of dexamethasone with clinical bupivacaine concentration can prolong the duration of anesthesia. Keywords: Supraclavicular, Brachial plexus block, Dexamethasone

Effects of double vs triple injection on block dynamics for ultrasound-guided intertruncal approach to the supraclavicular brachial plexus block in patients undergoing upper limb arteriovenous access surgery: study protocol for a double-blinded, randomized controlled trial

BackgroundUltrasound-guided intertruncal approach (IA) has been proposed to be an alternative and promising approach to the supraclavicular block (SCB), in which double injection (DI) of local anesthetics (LA) is sequentially administered between intertruncal planes. We would like to apply a refined injection technique, named triple injection (TI) technique, based on the 3 separate compartments visualized by ultrasound. The aim of this study is to compare the percentage of patients with complete sensory blockade at 20 min of DI vs TI technique, when they are applied in patients undergoing upper limb arteriovenous access surgery.MethodsThis study is a prospective parallel-group randomized controlled trial. A total of 86 end-stage renal disease patients will be randomly allocated to receive IA-SCB using either DI or TI technique with identical LA (0.5% ropivacaine 24 mL). The primary outcome is the percentage of patients with complete sensory blockade of all 4 terminal nerves (median, ulnar, radial, and musculocutaneous nerves) of the brachial plexus measured at 20 min after injection. The secondary outcomes will consist of the sensory or motor blockade of all individual nerves, onset times, performance time, diaphragmatic paralysis, surgical anesthesia, and adverse events.DiscussionIt is expected that ultrasound-guided IA-SCB with the TI technique results in better block dynamic in patients undergoing upper limb arteriovenous access surgery.Trial registrationChinese Clinical Trial Registry ChiCTR2100045075.

A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND CLONIDINE AS AN ADJUVANT TO ROPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Objectives: Ultrasound-guided supraclavicular brachial plexus block is the most commonly performed approach for the upper limb surgeries and perioperative pain relief. This study was conducted to compare the post-operative analgesic efficacy of dexmedetomidine and clonidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block in patients undergoing upper limb surgeries. Methods: This was a prospective, randomized, and double-blinded comparative research that included 60 ASA PS I and II patients who were scheduled for the upper limb surgery. The patients were randomized into two groups, namely, Group C and Group D, with 30 patients each. The patients in Group D were given USG-guided supraclavicular brachial plexus block with 30 ml of 0.5% ropivacaine and dexmedetomidine 1 μg/kg and patients in Group C received 30 ml of 0.5% ropivacaine and clonidine 1 μg/kg. The patients were monitored for post-operative and interpreted by visual analog score and duration of analgesia. The Student’s independent t-test was employed for comparing continuous variables. Chi-square test or Fisher’s exact test, whichever is appropriate, was applied for comparing categorical variables. Results: The mean duration of analgesia was longer and the mean consumption of rescue analgesics was lower in Group D as compared to Group C. No significant post-operative complications or local side effects related to the block were noted. Conclusion: Dexmedetomidine prolongs the duration of sensory and motor block as well as the duration of post-operative analgesia as compared to clonidine when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block.

A randomized comparison between ultrasound-guided costoclavicular and infraclavicular block for upper extremity surgery

Background/aim This study compared ultrasound guided costoclavicular (CC) and lateral sagittal infraclavicular (LS) brachial plexus block in patients undergoing upper extremity surgery.Materials and methods A total of 80 patients undergoing upper extremity surgery were randomly classified into two groups: Group CC (costoclavicular (n = 40)) and Group LS (lateral sagittal infraclavicular (n = 40)). Both groups received a 25 mL containing a mixture of 1% lidocaine and 0.25% bupivacaine. A blinded observer recorded the block onset time and decided which patients who were admitted to the operation room needed general anesthesia or rescue block or without any iv. narcotics for the surgical procedure.ResultsThe sensorimotor onset time was found to be faster in the CC group [(15.95 2.97) min] compared to the LS group [(17.72 4.15)min]. There was a statistically significant difference between two groups in terms of sensorimotor onset time (p = 0.031). There was no difference between two groups in terms of the block performance times and post-block motor block dissolution times. ConclusionThe CC approach provides faster onset of sensorimotor blockade than LS approach when the 4 major terminal nerves of the brachial plexus were evaluated.

Effectiveness of Nalbuphine with Ropivacaine in Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries

Objective: To investigate the effectiveness of ropivacaine in supraclavicular brachial plexus block by nalbuphine and compare it to ropivacaine alone. Study Design: Randomized controlled trial Place and Duration of Study: Department of Anaesthesia, Fatima Memorial Hospital/College of Medicine &amp; Dentistry, Lahore from 1st June 2020 to 31st March 2021. Methods: Ninety six patients of both genders with ages 20 to 65 years undergoing upper limb surgical procedure electively were included. All the patients were divided equally in to two groups, each group consist of 48 patients. Group A treated with ropivacaine with nalbuphine and group B treated with ropivacaine normal saline. Effectiveness between both groups was examined. Results: No significant difference was observed regarding age, gender, body mass index and ASA class I/II between both groups with p-value &gt;0.05.A significant difference was found regarding onset time of sensory and motor block between both groups (p=0.001). Mean sensory block duration in group A was more 425.18±17.82 minutes as compared to group B 254.43±20.44 minutes. Mean duration of motor block was also more in group A 418.65±20.84 minutes as compared to group B 226.15±12.52 minutes. Duration of analgesia was high in group A as compared to group B with p-value &lt;0.05. Conclusion: In supraclavicular brachial plexus block 0.75% with 10mg of nalbuphine is particularly effective in sensory, motor, and analgesic periods in relation to ropivacaine alone. Keywords: Supraclavicular, Brachial plexus block, Ropivacaine, Nalbuphine, Duration of analagesia

Diaphragmatic paralysis, respiratory function, and postoperative pain after interscalene brachial plexus block with a reduced dose of 10\u2009ml levobupivacaine 0.25% versus a 20\u2009ml dose in patients undergoing arthroscopic shoulder surgery: study protocol for the randomized controlled double-blind REDOLEV study

BackgroundArthroscopic shoulder surgery causes severe postoperative pain. An interscalene brachial plexus block provides adequate analgesia, but unintended spread of the local anesthetic administered may result in a phrenic nerve block, usually associated with a nonnegligible incidence of acute hemidiaphragmatic paralysis.The main purpose of this trial will be to analyze the incidence of hemidiaphragmatic paralysis ensuing after interscalene brachial plexus block in patients undergoing arthroscopic shoulder surgery administered a standard volume (20 ml) vs. a low volume (10 ml) of levobupivacaine 0.25%.MethodsThis will be a prospective double-blind randomized controlled single-center two-arm comparative trial. Forty-eight patients will be included. The primary goal will be to ultrasonographically determine the incidence of hemidiaphragmatic paralysis by calculating the diaphragmatic thickness ratio in each group. The secondary goals will be to compare the two arms in terms of (1) decrease in forced vital capacity and (2) in forced expiratory volume at 1 s by spirometry; (3) decrease in diaphragmatic excursion by ultrasound; (4) 24-h total intravenous morphine consumption; (5) time to first opioid request of a patient-controlled analgesia pump; and (6) postoperative complications.DiscussionThis trial will demonstrate that a low-volume interscalene brachial plexus block decreases hemidiaphragmatic paralysis following arthroscopic shoulder surgery according to spirometry and ultrasound measurements and does not provide inferior postoperative analgesia to the standard volume, as measured by opioid requirements.Trial registrationEudraCT and Spanish Trial Register (REec) registration number: 2019-003855-12 (registered on 7 January 2020). ClinicalTrials.gov identification number: NCT04385966 (retrospectively registered on 8 May 2020). Ethics Committee approval: EC19/093 (18 December 2019).

Comparison of Levobupivacaine and Levobupivacaine with Dexmedetomidine for Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries-A Randomised Controlled Trial

Introduction: Brachial plexus blockade at the supraclavicular level delivers an excellent regional anaesthetic technique with unmatched effectiveness for upper limb surgeries. Levobupivacaine, a safer alternative to the commonly used bupivacaine for regional anaesthesia and addition of α2-agonists like dexmedetomidine further improves the quality of regional anaesthesia. Aim: To evaluate the efficacy of levobupivacaine in combination with dexmedetomidine for supraclavicular brachial plexus block. Materials and Methods: This randomised controlled study enrolled 50 American Society of Anaesthesiologist (ASA) grade I and II patients aged between 18-60 years posted for elective upper limb surgeries. Randomisation was done and the patients were divided into two groups with 25 each, to receive either 39 mL of 0.5% levobupivacaine and 100 μgs (1 mL) of dexmedetomidine in group LD (Levobupivacaine with Dexmedetomidine) and 39 mL of 0.5% levobupivacaine and 1 mL of normal saline in group LS (Levobupivacaine with Saline). The onset and duration of sensory and motor blockade along with duration of analgesia were observed. All Quantitative data were compared and analysed using student’s unpaired t test while qualitative data were analysed using Chi-square test. A p-value of less than 0.05 was considered to be statistically significant. Results: The onset of sensory and motor blockade in group LD was significantly faster when compared to group LS (p&lt;0.001). group LD had a longer mean duration of sensory and motor blockade along with duration of analgesia when compared to group LS (p&lt;0.001). There was a better hemodynamic stability in group LD when compared to group LS. Conclusion: Dexmedetomidine added to levobupivacaine provides significantly shorter onset times, greatly prolongs the duration of sensory and motor blockade along with duration of analgesia without any systemic side effects.

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The Efficacy of Bupivacaine vs Bupivacaine with Dexamethasone for Supraclavicular Brachial Plexus Block in Patients Undergoing UpperLimb Surgeries

The Efficacy of Bupivacaine vs Bupivacaine with Dexamethasone for Supraclavicular Brachial Plexus Block in Patients Undergoing UpperLimb Surgeries

Addition of Dexamethasone to Bupivacaine for Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries

Addition of Dexamethasone to Bupivacaine for Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries