Brachial Plexus Block Research Articles

Exploring phantom phenomena following brachial plexus block in intact limbs.

For surgical procedures of the upper limbs, ultrasound-guided supraclavicular brachial plexus block (SCBPB) represents a safe substitute for general anesthesia. The present study evaluated the effectiveness and safety of incorporating 1μg/kg dexmedetomidine (DEX) into 20 ml bupivacaine, as opposed to using 20 ml and 30 ml bupivacaine without additives, in SCBPB. This randomized, controlled, double-blind study included 75 patients assigned to elective upper-limb surgery under the mid-humerus level. Patients were randomized into three equal groups to receive US-guided SCBPB with 20 ml bupivacaine 0.5% + 1 μg/kg DEX in group BD, 20 ml bupivacaine 0.5% without additives in group B20, and 30 ml bupivacaine 0.5% in group B30 (control). Compared to group B20, groups BD and B30 had significantly quicker onset times for sensory and motor blocks. Groups BD and B30 had a more significant block duration than group B20. Group BD experienced considerably lower intraoperative hemodynamics than groups B20 and B30. Groups BD and B30 had a significantly delayed time to first rescue analgesia and consumed less pethidine than group B20. Compared to group B20, the pain score was significantly reduced in groups BD and B30. Comparable levels of pain score, rescue analgesia time, total pethidine consumption, and motor and sensory block onset and duration were seen in the BD and B30 groups. DEX with a lower volume (20 ml) of bupivacaine reaches the same result as a higher volume of bupivacaine (30 ml) in managing perioperative pain and hemodynamic stability without the risk of the high volume of bupivacaine. Further, adding DEX to small dose of bupivacaine (20 ml) is more effective than small dose of bupivacaine (20 ml) alone without additives in prolonging the duration of sensory and motor block, reducing pain intensity, and delaying the need for rescue analgesia.

BackgroundThe superior trunk block (STB) has been proposed as an alternative to interscalene block for reducing the risk of hemidiaphragmatic paralysis (HDP) while maintaining adequate analgesia. However, the optimal local anesthetic dosage for STB has not been established. This study aimed to evaluate whether a low dose of ropivacaine could effectively provide surgical anesthesia, reduce the incidence of complete and partial HDP, and improve anesthetic safety and patient comfort during shoulder arthroscopy.MethodsEighty-eight patients scheduled for shoulder arthroscopy were enrolled and randomly allocated in a 1:1 ratio to either a low-dose group (LD group; 10 mL of 0.25% ropivacaine) or a conventional-dose group (CD group; 15 mL of 0.5% ropivacaine). The primary outcome was the incidence of HDP assessed at 3 h post-block. Secondary outcomes included rates of successful surgical anesthesia, pain scores, opioid consumption, duration and onset time of the block, handgrip strength, and patient satisfaction.ResultsThe incidence of complete and partial HDP at 3 h post-STB was significantly lower in the LD group than in the CD group (31.8% vs. 84.1%, p < 0.001), with an absolute risk reduction of 52.3% (95% CI: 34.8% to 69.8%). All patients in both groups successfully underwent surgery without conversion to general anesthesia with tracheal intubation or requiring supplemental intraoperative analgesia. The overall patient satisfaction score was significantly higher in the LD group compared to the CD group (p = 0.003). However, patients in the LD group reported higher pain scores at 12 h post-block (p = 0.044), exhibited a shorter duration of sensory block (p = 0.001) compared to the CD group.ConclusionsThese findings indicate that a low-dose ropivacaine regimen (10 mL of 0.25%) for STB significantly reduces the incidence of HDP while still providing sufficient surgical anesthesia. However, this approach may be associated with reduced efficacy in postoperative analgesia.Trial registrationThis trial was registered at the Chinese Clinical Trial Registry (No. ChiCTR2000036608).

Safe and Effective Analgesia Using Ultrasound-Guided Brachial Plexus Block for Upper Limb Compartment Syndrome: A Case Report

BackgroundAlthough interscalene nerve block is considered as the standard analgesic method for arthroscopic shoulder surgery, it is not indicated for patients with respiratory comorbidity. Periarticular infiltration is usually used for postoperative analgesia following orthopedic surgery, with uncertain analgesic effects. Infraspinatus-teres minor interfascial (ITM) block is an innovative method used in arthroscopic shoulder surgery. We supposed that ITM block combined with periarticular infiltration could provide adequate analgesia for patients undergoing arthroscopic shoulder surgery.MethodsThis is a randomized, parallel-controlled, prospective, single-center study. Fifty-six patients scheduled for arthroscopic shoulder surgery will be randomized into two groups: ITM block combined with periarticular infiltration group (ITM group) and periarticular infiltration group (PAI group). Periarticular infiltration will be administered to all patients following surgery. The primary outcome is the time from the end of surgery to the first press of the patient-controlled analgesia pump (PCA) in the two groups. Secondary outcomes are the following: intraoperative remifentanil and propofol consumption, hemodynamic changes, VAS scores, frequency of PCA compression, remedy analgesic consumption, length of hospital stay, patients satisfaction score, and adverse reactions.DiscussionThis study will demonstrate the analgesic efficacy of ITM block combined with periarticular infiltration in arthroscopic shoulder surgery.Trial registrationChinese Clinical Trial Registry (https://www.chictr.org.cn/) ChiCTR2400088821. Registered on 27 August 2024.

Introduction: Anesthetic management for non-neurosurgical procedures in patients with recent severe traumatic brain injury (TBI) presents a formidable challenge. General anesthesia carries inherent risks of hemodynamic instability and increased intracranial pressure (ICP), which can precipitate devastating secondary brain injury. Regional anesthesia offers a neuroprotective alternative, though its application in this specific high-risk population is not extensively documented. Case presentation: A 24-year-old male, ASA status III-E, required open reduction and internal fixation of a clavicle fracture six days after an emergency decompressive craniectomy for an acute epidural hematoma. To mitigate neurological risk, a definitive anesthetic plan consisting of an ultrasound-guided dual plexus blockade was implemented. This involved a combination of an interscalene brachial plexus block (15 mL of 0.375% levobupivacaine) and a superficial cervical plexus block (10 mL of 0.375% levobupivacaine), supplemented with light, non-opioid sedation using dexmedetomidine. The 150-minute surgery was completed with exceptional hemodynamic stability, no requirement for airway manipulation, and no anesthetic or surgical complications. The patient remained comfortable and neurologically intact throughout. Conclusion: This case demonstrates that an ultrasound-guided dual plexus blockade is a safe, effective, and neurologically protective primary anesthetic technique for clavicle surgery in the post-craniotomy patient. By providing dense surgical anesthesia while preserving stable cerebral perfusion pressure, this approach represents a superior alternative to general anesthesia in this fragile patient population. We advocate for its consideration in similar clinical scenarios.

Effect of liposomal bupivacaine for the suprascapular nerve combined with axillary nerve block on postoperative analgesia in patients undergoing shoulder surgery: a randomized, observer-blinded trial

Efficacy of magnesium sulfate as an adjuvant to local anesthetics in supraclavicular brachial plexus block: a meta-analysis of randomized trials.

PurposeThis study examined whether chronic opioid use reduces the effectiveness of brachial plexus block in patients undergoing upper extremity surgery.Patients and MethodsPatients undergoing surgery with brachial plexus blocks were divided into two groups: opioid-dependent (daily opioid use for ≥1 month) and control (no opioid use for ≥3 months). Pain scores and opioid use were recorded over 72 hours postoperatively.ResultsForty-six patients were included (23 opioid-dependent and 23 control). The median (IQR) NRS scores upon PACU arrival were 0 (0–0) in the control group and 0 (0–5) in the opioid group (p=0.0101). The duration of the nerve block was shorter in opioid-dependent patients (14 versus 22 hours; p=0.0035).ConclusionChronic opioid users experienced shorter brachial plexus block duration and more postoperative pain after being discharged home.

The continuous interscalene brachial plexus block (ISB) is widely used for regional anesthesia in shoulder surgeries. Although the continuous costoclavicular brachial plexus block (CCB) has been proposed, its comparative efficacy and safety remain unclear. This randomized, single-blind trial aimed to determine whether the CCB offers non-inferior postoperative analgesia compared to the ISB while mitigating hemidiaphragmatic paresis (HDP). patients underwent rotator cuff repair received continuous ISB or CCB followed by 0.2% ropivacaine infusion postoperatively. The primary outcome was the resting numerical rating scale (NRS) pain score 24 h postoperatively. Secondary outcomes included block-related parameters, dynamic and resting pain scores, HDP incidence, opioid consumption, rescue analgesia requirements, and satisfaction scores. Resting NRS scores at 24 h demonstrated the non-inferiority of the CCB compared to the ISB (2.41 ± 0.59 vs. 2.00 ± 0.81; mean difference: 0.41; 95% CI: 0.1-0.73). The CCB significantly reduced the incidence of early complete HDP (30 min post-block: 7.3% vs. 41.5%; P < 0.001), with no incidence of complete HDP at 24 h. The CCB had longer block times (19.2 ± 3.7 vs. 17.2 ± 3.6 min; P = 0.013) and sensory onet (24.0 [21.0-24.0] vs. 18.0 [18.0-21.0] min; P < 0.001). Total ropivacaine consumption, rescue analgesia, or satisfaction scores were comparable. The continuous CCB is non-inferior to the ISB in terms of postoperative analgesia after rotator cuff repair and substantially decreases the risk of HDP. These findings support the CCB as a clinically advantageous alternative for shoulder surgery analgesia.

PurposeRebound pain (RP) often occurs after the resolution of peripheral nerve blocks. Studies suggest that perineural esketamine prolongs block duration and reduces RP incidence. This study aimed to determine whether intravenous esketamine reduces RP incidence following single-shot interscalene brachial plexus block (ISBPB) in shoulder arthroscopic surgery.Patients and methodsIn this randomized controlled trial, 200 patients scheduled for shoulder arthroscopy received ultrasound-guided single-shot ISBPB preoperatively and were randomized to receive either intravenous esketamine (0.5 mg/kg bolus + 0.25 mg/kg/h infusion) or placebo. Primary outcomes included RP incidence, onset time, duration, and pain scores. Secondary outcomes included block duration, postoperative pain scores, and hemodynamic parameters (heart rate [HR], mean arterial pressure [MAP]).ResultsThe incidence rates of rebound pain (RP) were comparable between groups, with no significant differences in RP duration or pain scores (P>0.05). However, the Numeric Rating Scale at rest (NRS-R) scores at 8h, 12h, and 24h postoperatively were significantly higher in the C-group compared to the E-group (P<0.05). Hemodynamic stability was superior in the E-group during immediately post-administration (T4) to skin incision (T8), with higher MAP at T6–T10 (P<0.05). Sensory/motor block onset and duration showed no intergroup differences (P>0.05). Adverse events (dizziness, nausea) were comparable, with one transient hallucination in the E-group.ConclusionPatients undergoing arthroscopic rotator cuff repair under combined single-shot interscalene brachial plexus block and general anesthesia exhibit a rebound pain incidence of approximately 25%. Intravenous administration of esketamine (0.5 mg/kg bolus followed by continuous infusion at 0.25 mg/kg/h) during the operation failed to significantly reduce the incidence of rebound pain post-block (P>0.05). However, it demonstrated significant reductions in pain scores at 8h, 12h, and 24h postoperatively (P<0.05), with enhanced hemodynamic stability observed from anesthetic induction to pre-incision periods. No severe adverse events were reported.

Introduction: Post-traumatic radioulnar synostosis is a rare complication with disabling consequences for prognostic function. Several factors predictive of its occurrence should be taken into account when managing a fracture of the two bones of the forearm. We report a case of radioulnar synostosis complicating a complex open fracture of both forearm bones. The aim is to identify factors favouring the occurrence of synostosis after osteosynthesis of the two bones of the forearm. Case report: A 55-year-old female patient with no significant medical history, presenting with a complex open fracture of both forearm bones treated with intramedullary nailing, with postoperative radiography showing several bone fragments filling the interosseous membrane opposite the fracture sites. During the procedure, she developed radioulnar synostosis with repercussions on prono-supination function, which required surgery. The surgical procedure was performed under right supraclavicular block. The lesion was approached via a posterolateral approach of the forearm, and exploration revealed a significant bone bridge between the ulna and radius. A large bone fragment was excised using osteotomes, followed by curettage of the bone resection edges. No fibrous tissue was interposed between the resection borders. At the 12-month follow-up, there was good recovery of prono-supination function with no recurrence on follow-up X-rays. Conclusion: Post-traumatic radioulnar synostosis remains a complication with serious consequences for forearm function. Complex fractures with fragments in the interosseous limb, before or after surgery, are a risk factor for synostosis.

Comparison of WALANT (Wide Awake Local Anesthesia Without Tourniquet) technique and infraclavicular brachial plexus block in cubital tunnel decompression surgery.

Ulnar artery Doppler indices, a novel emerging predictor of segmental ulnar sparing after supraclavicular block: A prospective observational study.

Pain management with ketamine procedural sedation and infraclavicular block for forearm fracture in the emergency department.

Comparison between Functional Outcomes of Flexor Tendon Repair Under Wide-Awake Local Anaesthesia No Tourniquet and Brachial Plexus Block

Effect of Anesthetic Technique on Early Patency of Radiocephalic Arteriovenous Fistulas in Patients Requiring Hemodialysis.

Use of smart glasses imaging for interscalene brachial plexus block: a randomised clinical trial.

Supraclavicular Brachial Plexus Block with and without Dexmedetomidine as an Adjuvant to 0.25% Bupivacaine: A Randomized Controlled Trial

Adding adjuvants to local anesthetics can improve the efficacy of peripheral nerve blocks. However, the literature supporting the advantages of esketamine on peripheral nerve blocks remains limited. This study aims to assess whether adjunctive esketamine enhances the duration of postoperative analgesia when added to ropivacaine in supraclavicular brachial plexus block (SBPB). In this randomized controlled trial, 117 adult patients scheduled for distal radius fracture surgery received either 30 mL of 0.4% ropivacaine alone or 30 mL of 0.4% ropivacaine with 25 mg of esketamine in the SBPB. The primary outcome was the analgesic duration of SBPB, defined as the first time a patient experienced pain postoperatively. Secondary outcomes included the SBPB onset time, motor block duration, and pain scores 48 h after surgery. The incidence of adverse events was recorded. No significant difference in analgesic duration was found between the two groups (11.3 [10.1, 12.4] h vs. 10.8 [9.4, 12.2] h, median difference = 0.3, 95% confidence interval, -0.4-1.0, P=0.344). Meanwhile, no significant differences were found in SBPB onset time, motor block duration, or pain scores between the groups. The incidences of Horner syndrome, hoarseness, postoperative nausea and vomiting were comparable between the groups. Adding 25 mg esketamine to 30 mL of 0.4% ropivacaine did not improve the analgesic efficacy of SBPB in patients undergoing distal radius fracture surgery. These findings suggest that the limited benefits of esketamine in peripheral nerve blocks such as SBPB warrant further investigation to optimize agent design.