Brachial Plexus Nerve Block Research Articles

The Effects of Perineural Versus Intravenous Dexamethasone on Sciatic Nerve Blockade Outcomes

Perineural dexamethasone has been investigated as an adjuvant for brachial plexus nerve blocks, but it is not known whether the beneficial effect of perineural dexamethasone on analgesia duration leads to a better quality of surgical recovery. We hypothesized that patients receiving dexamethasone would have a better quality of recovery than patients not receiving dexamethasone. We also sought to compare the effect of perineural with that of IV dexamethasone on block characteristics. Patients undergoing elective ankle and foot surgery were recruited over a 9-month period. Patients received ultrasound-guided sciatic nerve blocks by using 0.5% bupivacaine with epinephrine 1:300,000 (0.45 mL/kg) and were randomized into 3 groups: group 1 = perineural dexamethasone 8 mg/2 mL with 50 mL IV normal saline, group 2 = perineural saline/2 mL with IV 8 mg dexamethasone in 50 mL normal saline, and group 3 = perineural saline/2 mL with 50 mL normal saline. The primary outcome was the global score in the quality of recovery (QoR-40). The secondary outcomes included analgesia duration, opioid consumption, patient satisfaction, numeric pain rating scores, and postoperative neurologic symptoms. Eighty patients were randomized, and 78 patients completed the study protocol. There was no improvement in the global QoR-40 score at 24 hours between the perineural dexamethasone and saline, median (97.5% CI) difference of -3 (-7 to 3); IV dexamethasone and saline, median difference of -1 (-8 to 5); or perineural dexamethasone and IV dexamethasone median difference of -2 (-6 to 5). Analgesia duration (P < 0.001) and time to first toe movement (P < 0.001) were prolonged by perineural dexamethasone compared with saline. IV dexamethasone prolonged time to first toe movement compared with saline (P = 0.008) but not analgesia duration (P = 0.18). There was no significant difference in the time to first toe movement or analgesia duration between the perineural and IV dexamethasone groups. Postoperative opioid consumption was not different among study groups. Self-reported neurologic symptoms at 24 hours were not different among perineural dexamethasone (17, 63%), IV dexamethasone (10, 42%), or normal saline (8, 30%) (P = 0.31). All postoperative neurologic sequelae were resolved by 8 weeks. Preoperative administration of IV and perineural dexamethasone compared with saline did not improve overall QoR-40 or decrease opioid consumption but did prolong analgesic duration in patients undergoing elective foot and ankle surgery and receiving sciatic nerve block. Given the lack of clinical benefit and the concern of dexamethasone neurotoxicity as demonstrated in animal studies, the practice of perineural dexamethasone administration needs to be further evaluated.

Ultrasound-guided supraclavicular versus infraclavicular brachial plexus nerve block in chronic renal failure patients undergoing arteriovenous fistula creation

BackgroundMost patients with chronic renal failure suffer from complications that make brachial plexus block a good choice for providing anesthesia. The use of ultrasonography increases the success rate and decreases complications. We compared the efficacy of ultrasound-guided supraclavicular and infraclavicular brachial plexus block in providing anesthesia for creation of arteriovenous fistula.Patients and methodsSixty adult patients with chronic renal failure, scheduled for creation of arteriovenous fistula of the distal upper extremity were randomly divided into two equal groups: Supra G (n = 30): ultrasonic guided supraclavicular brachial plexus block was given and Infra G (n = 30): ultrasonic guided infraclavicular brachial plexus block was given. For both groups we used 20–25 cm 1:1 volumes of 0.5% bupivacaine and 2% lidocaine. The measured parameters were block performance time and related pain, the degree and duration of sensory and motor block, patient discomfort, first call for analgesics, complications and the patient’s satisfaction.ResultsThere was no statistically significant difference between both groups as regard the block performance time, the block related pain, the degree of sensory and motor block in the areas supplied by the median, radial and musculocutaneous nerves at 10, 20 and 30 min. There was no statistically significant difference as regard the sensory block grade in the area supplied by the ulnar nerve at 10 min, but it was significantly higher in the Supra G than Infra G at 20 and 30 min. No statistically significant difference as regard the motor block grade in the area supplied by the ulnar nerve, the block duration, first call for analgesia, complications and patients’ satisfaction.ConclusionBoth approaches can provide satisfactory sensory and motor block, very good analgesia that extends for a long time postoperatively in patients with chronic renal failure undergoing creation of arteriovenous fistula.

Dexamethasone a Promising Adjuvant in Brachial Plexus Anesthesia? A Systematic Review

The benefit of adjuvant dexamethasone in regional anesthesia has recently been the focus of investigation as clinical reports suggest improved block characteristics. However, its use remains off label and few large randomized controlled trials have been completed. A systematic review was undertaken to highlight current research efforts and findings in this area. The authors searched for randomized clinical trials evaluating dexamethasone as admixture in brachial plexus nerve blocks. Eleven trials involving brachial plexus block met inclusion criteria (953 patients, 456 received dexamethasone). Local anesthetic agents studied included lidocaine, mepivacaine, bupivacaine and ropivacaine. Dosing ranged from 4 to 10 mg with the majority of trials using 8 mg (9 trials). Permanent nerve injury or serious complications were not reported in any trial. Trials consistently demonstrated significant prolongation of analgesia (1.5 to 4.0 times) regardless of which local anesthetic was utilized. The effect of dexamethasone on block onset was variable and its clinical benefit unclear. Dexamethasone consistently reduced postoperative pain scores and early opioid consumption (≤ 48 hours), but did not impact total opiate consumption. The most recent evidence raises the possibility of a systemic mechanism of action, potentially eliminating the need for perineural administration. In conclusion, adjuvant dexamethasone significantly prolongs the duration of analgesia when used in brachial plexus nerve blockade and has not been associated with any adverse complications to date. Large clinical trials with particular focus on systemic versus perineural administration are required to better evaluate the clinical use and safety profile of this promising adjuvant in regional anesthesia.

A triple-masked, randomized controlled trial comparing ultrasound-guided brachial plexus and distal peripheral nerve block anesthesia for outpatient hand surgery.

Background. For hand surgery, brachial plexus blocks provide effective anesthesia but produce undesirable numbness. We hypothesized that distal peripheral nerve blocks will better preserve motor function while providing effective anesthesia. Methods. Adult subjects who were scheduled for elective ambulatory hand surgery under regional anesthesia and sedation were recruited and randomly assigned to receive ultrasound-guided supraclavicular brachial plexus block or distal block of the ulnar and median nerves. Each subject received 15 mL of 1.5% mepivacaine at the assigned location with 15 mL of normal saline injected in the alternate block location. The primary outcome (change in baseline grip strength measured by a hydraulic dynamometer) was tested before the block and prior to discharge. Subject satisfaction data were collected the day after surgery. Results. Fourteen subjects were enrolled. Median (interquartile range [IQR]) strength loss in the distal group was 21.4% (14.3, 47.8%), while all subjects in the supraclavicular group lost 100% of their preoperative strength, P = 0.001. Subjects in the distal group reported greater satisfaction with their block procedures on the day after surgery, P = 0.012. Conclusion. Distal nerve blocks better preserve motor function without negatively affecting quality of anesthesia, leading to increased patient satisfaction, when compared to brachial plexus block.

The use of train of four monitoring for clinical evaluation of the axillary brachial plexus block

The axillary approach of brachial plexus anesthesia is the most commonly used technique for forearm and hand surgery. Dynamometer is known as objective test for the clinical assessment of motor block of the nerves in brachial plexus block. However, the use of this device may not always be practical in operating room. The train-of-four (TOF) test is a non-invasive peripheral nerve stimulator that shows the level of motor block of muscle relaxants. The aim of the study is to investigate the use of TOF testing as a peripheral nerve stimulator for objective clinical evaluation of motor block at axillary brachial plexus block. 44 patients were randomized according to the development of partial or complete motor in the axillary brachial plexus block. The nerves were selectively localized by nerve stimulation and ultrasound guidance. After obtaining an appropriate peripheral motor response, predetermined volumes of bupivacaine were selectively injected to the 4 nerves. Sensory, motor block levels and TOF values were measured at 10th, 20th, 30th minutes immediately after the axillary brachial plexus block. TOF values were gradually decreased and significant difference was observed between the development of a complete and partial motor block at 30th minute. TOF values were also significantly less in patients of complete sensory block than the patients of partial sensory block at 30th minute. The use of TOF monitoring may be beneficial to assess the objective clinical effect of motor block in the patients with axillary brachial plexus nerve block.

Infraclavicular brachial plexus nerve block via a coracoid approach: comparison of the anesthestic effects between the classic method and the modified method

Objective To investigate the impact of the modified and classic coracoid approach for localization in the infraclavicular brachial plexus nerve block.Methods Eighty patients schedtded for elective surgical procedures under infraclavicular brachial plexus block were randomly divided into two groups.The puncture point of Group A was the classic Wilson's approach via the point 2 cm medial and caudal to the coracoid process.The puncture point of Group B was modified by surface projection of the brachial plexus.Peripheral nerve stimulator was used to confirm the proper localization of the plexus.The performance time,the number of puncture,the anesthesia success rate,the incidence of complications and patient satisfaction were recorded.Results The performance time of the modified group was less than that of the classic group (P ＜ 0.01).The chance of locating the bmchial plexus in a single puncture without adjusting the block needle was significantly higher in the modified group (P ＜ 0.05).Conclusion The modified coracoid approach can significantly improve the probability of locating the nerve in one puncture that reduces the performance time.It improves the accuracy of puncture point position on the body surface. Key words: Nerve block; Brachial plexus; Coracoid approach; Peripheral nerve stimulator

General anesthesia combined with brachial plexus nerve block enhances the anesthesia quality in arthroscopic shoulder surgery

Objective To evaluate the efficacy of anesthesia with general anesthesia combined with brachial plexus block in shoulder arthroscopy.Methods Forty-four patients (ASA Ⅰ or Ⅱ,aged 35 y-65 y,undergoing shoulder arthroscopy) were randomized into group A and B (n=22,each).While both groups having received inhalation-intravenous general anesthesia (GA),group B also received ultrasound-guided interscalene brachial plexus block with 0.2％ ropivacaine 20 ml before GA.The HR,SBP,DBP and MAP at entering operation room,before skin incision,at skin incision,30,60,90 min after skin incision,and 30 min after tracheal extubation,the use of sufentanyl,rocuronium,isosorbide dinitrate and esmolol,and SaO2,PaO2 and PaCO2 before and after surgery,and the spontaneous respiration regaining time,tracheal extubation time and fully consciousness regaining time,and the visual analog scale (VAS) of pain,analgesics application and complications in the PACU were recorded.Results The HR and MAP at skin incision,and the minimum alveolar concentration (MAC) of sevoflurane and dosage per weight of sufentanyl in group A and B were (68±11) bpm and (63±7) bpm,(86±15) mm Hg and (69±10) mm Hg(1 mm Hg=0.133 kPa),(1.28±0.21) MAC and (1.08±0.20) MAC,(0.54±0.08) μg/kg and(0.34±0.06) μg/kg,respectively(P＜0.001).The cases that needed esmolol or isosorbide dinitrate,the post-operation PaCO2 and the tracheal extubation time in group A and B were 12 and 2 cases,(13±10) min and (7±4)min,(44±3) mm Hg and (42±3) mm Hg,respectively (P＜0.05).The pain VAS of group A and B were (4±2) and (0±2),respectively (P＜0.001).There were no significant statistic differences between the two groups in relevant complications (P＞0.05).Conclusions Brachial plexus block combined with general anesthesia enhances the anesthesia quality in shoulder arthroscopy,which not only reduces the fluctuation of blood pressure,decreases the use of narcotic analgesics and short-acting antihypertensive agents,but also shortens the tracheal extubation time,and has short-time postoperative analgesic effect and no severe complications. Key words: Shoulder arthroscopy; Brachial plexus nerve block; General anesthesia; Anesthesia quality

Parecoxib Added to Ropivacaine Prolongs Duration of Axillary Brachial Plexus Blockade and Relieves Postoperative Pain

Cyclooxygenase (COX)-2 antagonist is widely used for intravenous postoperative pain relief. Recent studies reported COX-2 in the spinal dorsal horn could modulate spinal nociceptive processes. Epidural parecoxib in rats showed no neurotoxicity. These findings suggested applying a COX-2 antagonist directly to the central or peripheral nerve might provide better analgesia. We therefore determined: (1) whether the addition of parecoxib to ropivacaine injected locally on the nerve block affected the sensory and motor block times of the brachial plexus nerve block; and (2) whether parecoxib injected locally on the nerve or intravenously had a similar analgesic adjuvant effect. We conducted a randomized controlled trial from January 2009 to November 2010 with 150 patients scheduled for elective forearm surgery, using a multiple-nerve stimulation technique. Patients were randomly allocated into one of three groups: Group A (n=50) received ropivacaine 0.25% alone on the brachial plexus nerve; Group B (n=50) received ropivacaine together with 20mg parecoxib locally on the nerve block; and Group C (n=50) received 20mg parecoxib intravenously. We recorded the duration of the sensory and motor blocks, and the most severe pain score during a 24-hour postoperative period. Parecoxib added locally on the nerve block prolonged the motor and sensory block times compared with Group A. However, parecoxib injected intravenously had no such effect. Pain intensity scores in Group B were lower than those in Groups A and C. Parecoxib added to ropivacaine locally on the nerve block prolonged the duration of the axillary brachial plexus blockade and relieved postoperative pain for patients having forearm orthopaedic surgery. Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The comparison of different ultrasound-guided interscalene brachial plexus block injection methods on the effect of anesthesia

Objective To compare the effect of interscalene brachial plexus block using three kinds of uhrasound-guidedinjection methods.Methods Ninety ASA Ⅰ -Ⅱ patients scheduled for surgery of the shoulder or the upper extremity were randomly divided into three groups (n=30),S group:ultrasound-guided and single-point-injection group,M group:ultrasound-guided and three-point-injection group,R group:ultrasound-guided multiple injection group using as little local anesthetic as assessed by sonography that the nerve was soaked by local anesthetic.A total dose of 30 ml ropivocaine was injected in the S and M group.In the R group,if the stems of brachial plexus were coated to show donut sign,then we stopped injecting local anesthetic.Results The average onset time of sensory blockade on the area innervated by the medial antebrachial cutaneous nerve and the medial brachial cutaneous nerve in the M group (7.6±2.3) min and (6.0±2.2) min and R group (8.2+2.6) min and (7.6+2.7) min was significantly shorter than that in the S group (9.2+3.1) min and (10.6±2.8) min.The rate of satisfactory sensory blockade on the area innervated by the medial brachial cutaneous nerve in the S group (60％) was significantly lower than in the M group (100％) and R (94.3％).The incidence of complications in the M group (60％) was significantly higher than in the S group (20％).Conclusions The ultrasound-guided multi-point interscalene brachial plexus nerve block can speed up the block onset time of the medial antebrachial cutaneous nerve and the medial brachial cutaneous nerve and improve the success rate of interscalene brachial plexus nerve block.Multi-point injection of local anesthetic can increase the incidence of complications. Key words: Ultrasonagraphy; Braehial plexus; Nerve block

Sonographic evaluation of a paralyzed hemidiaphragm from ultrasound-guided interscalene brachial plexus nerve block

The ultrasound-guided interscalene brachial plexus is becoming increasingly popular for anesthesia in the management of upper-extremity injuries by emergency physicians. Traditional high-volume injections of local anesthesia will also affect the phrenic nerve, leading to temporary paralysis of the ipsilateral hemidiaphragm. With direct ultrasound guidance, more precise needle placement allows for lower-volume injections that reduce inadvertent spread of local anesthetic to the phrenic nerve without decreasing the efficacy of onset of time and quality of the block. However, the risk of incidental paralysis of the hemidiaphragm is still not eliminated with low-volume intraplexus injections. This case highlights this common complication of interscalene brachial plexus nerve blocks and demonstrates how emergency physicians can easily use B-mode and M-mode ultrasound to evaluate the paralysis of the hemidiaphragm.

Brachial Plexus Blocks for Upper Extremity Orthopaedic Surgery

Regional anesthesia of the upper extremity has several clinical applications and is reported to have several advantages over general anesthesia for orthopaedic surgery. These advantages, such as improved postoperative pain, decreased postoperative opioid administration, and reduced recovery time, have led to widespread acceptance of a variety of regional nerve blocks. Interscalene block is the most commonly used block for shoulder surgery. Other brachial plexus nerve blocks used for orthopaedic surgery of the upper extremity are supraclavicular, infraclavicular, and axillary. Several practical and theoretical aspects of regional nerve blocks must be considered to optimize the beneficial effects and minimize the risk of complications.

Stroke, Regional Anesthesia in the Sitting Position, and Hypotension

Intraoperative hypotension is used to reduce surgical bleeding. Case reports of stroke after general anesthesia in the sitting position led us to collect data (patient demographics, medical risk factors for stroke, intraoperative hemodynamics) about the incidence of stroke after surgery in the sitting position. This study reviewed 4169 (3000 retrospective, 1169 prospective) ambulatory shoulder surgeries in the sitting position. For the prospective cohort, patients were queried postoperatively regarding stroke, with corroboration from 4 databases (anesthesia department quality assurance, hospital case management, state-reportable events, and hospital information system diagnostic code databases). For the retrospective cohort, rate of stroke was determined via the same 4 databases. No patient had a stroke (95% confidence interval, 0%-0.07%). Risk factors for perioperative stroke were present in 40% of patients. Brachial plexus nerve block with intravenous sedation was used for 95.7% (retrospective) and 99.8% (prospective) of the cohorts. Many patients (47%) experienced intraoperative hypotension by at least one definition: 40% (retrospective) and 30% (prospective) had at least a 30% decrease in mean arterial pressure; 27% (retrospective) and 24% (prospective) had a mean pressure less than 66 mm Hg; and 13% (retrospective) and 12% (prospective) had a systolic blood pressure of less than 90 mm Hg. No strokes were observed in 4169 patients. The estimated upper limit of the 95% confidence interval for stroke after regional anesthesia for shoulder surgery in the seated position is 0.07%, despite frequent incidence of hypotension.

(P2-78a) Feasibility and Safety of Ultrasonography-Guided Nerve Blocks Performed by Emergency Physicians in the Emergency Department

BackgroundEmergency physicians often encounter patients who require procedural sedation and analgesia (PSA) for the treatment of acute traumatic injuries like fracture reduction, joint dislocation reduction, wound care, and pain relief. Its complications include airway or circulatory compromise. Ultrasound (US) guided peripheral nerve block is a safe alternative that utilizes minimal amounts of local anesthetic and does not require hemodynamic monitoring or prolonged post-procedure observation.ObjectiveThe objective of this study is to determine the feasibility and safety of ultrasonography-guided nerve blocks, performed by emergency physicians.MethodsA prospective study involving 28 patients &gt; 12 years of age presenting to an emergency department (ED) were recruited after informed consent. Ultrasonography-guided nerve blocks were performed by emergency physicians who underwent a minimal training of 10 supervised nerve blocks. Brachial plexus, forearm, and lower-limb nerve blocks were performed as deemed necessary. Verbal analogue scale (VAS) was used to quantify pain, before and five minutes after the procedure. The outcomes for feasibility and safety were the percentage of cases in which no further anesthesia was required, the median reduction in VAS score, median time to completion of procedure and the complication rate noted during the procedure.ResultsAll procedures were completed without additional anesthesia. The different nerve blocks performed were brachial plexus (20 cases, 71.4%), forearm (3 cases, 10.7%), femoral (2 cases, 7.1%), combined femoral and sciatic (2 cases, 7.1%) and tibial (1 case, 3.6%). Median reduction in VAS score was 7.0 points (interquartile range 6.0, 8.0; p &lt; 0.001). The median time to completion of nerve blocks was 5 minutes per patient (interquartile range 2 minutes 25 seconds, 10 minutes 0 seconds). There were no immediate complications noted after the procedure.ConclusionsEmergency physicians with minimal training can perform ultrasonography-guided nerve blocks safely, quickly and without the need for additional anesthesia in the ED.

ULTRASOUND CONTROL IN BRACHIAL PLEXUS BLOCK ANESTHESIA (literature review)

This is a review of the publications devoted to the techniques of brachial plexus nerve block anesthesia conducted under ultrasound control. There is a certain gap in the knowledge about the usage of ultrasound control for this kind of block anesthesia and this often leads to complications invoked after the mentioned manipulation.

Analgesic efficacy of ultrasound-guided regional anesthesia: a meta-analysis

Study Objective To determine if the use of ultrasound guidance (vs non-ultrasound techniques) improves the success rate of nerve blocks. Design Meta-analysis of randomized controlled trials (RCTs) in the published literature. Setting University medical center. Measurements 16 RCTs of patients undergoing elective surgical procedures were studied. Patients underwent ultrasound-guided or non-ultrasound techniques (nerve stimulation, surface landmark) for peripheral nerve blocks. Success rates were measured. Main Results Ultrasound guidance (vs all non-ultrasound techniques) was associated with a significant increase in the success rate of nerve blocks [relative risk (RR) = 1.11 (95% confidence interval [CI]: 1.06 to 1.17, P < 0.0001]). When compared with nerve stimulator techniques only, ultrasound guidance was still associated with an increase in the success rate (RR = 1.11 [95% CI: 1.05 to 1.17, P = 0.0001]). For specific blocks, ultrasound guidance (vs all non-ultrasound) was associated with a significant increase in successful brachial plexus (all) nerve blocks (RR = 1.11 [95% CI: 1.05 to 1.20, P = 0.0001]), sciatic popliteal nerve block (RR = 1.22 [95% CI: 1.08 to 1.39, P = 0.002]) and brachial plexus axillary nerve block (RR = 1.13 [95% CI: 1.00 to 1.26, P = 0.05]) but not brachial plexus infraclavicular nerve block (RR = 1.25 [95% CI: 0.88 to 1.76, P = 0.22]). Conclusions Ultrasound-guided peripheral nerve block is associated with an increased overall success rate when compared with nerve stimulation or other methods. Ultrasound-guided techniques also increase the success rate of some specific blocks.

Ultrasound-guided approach for axillary brachial plexus, femoral nerve, and sciatic nerve blocks in dogs

ObjectiveTo describe an ultrasound-guided technique and the anatomical basis for three clinically useful nerve blocks in dogs. Study designProspective experimental trial. AnimalsFour hound-cross dogs aged 2 ± 0 years (mean ± SD) weighing 30 ± 5 kg and four Beagles aged 2 ± 0 years and weighing 8.5 ± 0.5 kg. MethodsAxillary brachial plexus, femoral, and sciatic combined ultrasound/electrolocation-guided nerve blocks were performed sequentially and bilaterally using a lidocaine solution mixed with methylene blue. Sciatic nerve blocks were not performed in the hounds. After the blocks, the dogs were euthanatized and each relevant site dissected. ResultsAxillary brachial plexus block Landmark blood vessels and the roots of the brachial plexus were identified by ultrasound in all eight dogs. Anatomical examination confirmed the relationship between the four ventral nerve roots (C6, C7, C8, and T1) and the axillary vessels. Three roots (C7, C8, and T1) were adequately stained bilaterally in all dogs. Femoral nerve blockLandmark blood vessels (femoral artery and femoral vein), the femoral and saphenous nerves and the medial portion of the rectus femoris muscle were identified by ultrasound in all dogs. Anatomical examination confirmed the relationship between the femoral vessels, femoral nerve, and the rectus femoris muscle. The femoral nerves were adequately stained bilaterally in all dogs. Sciatic nerve blockUltrasound landmarks (semimembranosus muscle, the fascia of the biceps femoris muscle and the sciatic nerve) could be identified in all of the dogs. In the four Beagles, anatomical examination confirmed the relationship between the biceps femoris muscle, the semimembranosus muscle, and the sciatic nerve. In the Beagles, all but one of the sciatic nerves were stained adequately. Conclusions and clinical relevanceUltrasound-guided needle insertion is an accurate method for depositing local anesthetic for axillary brachial plexus, femoral, and sciatic nerve blocks.

Development of an Avian Brachial Plexus Nerve Block Technique for Perioperative Analgesia in Mallard Ducks (Anas platyrhynchos)*

Surgical procedures of the wing are commonly performed in companion, captive, and wild avian species. To develop a clinically applicable brachial plexus nerve block technique for perioperative analgesia in birds, 8 adult female mallard ducks (Anas platyrhynchos) were anesthetized and used in several local anesthetic trials with bupivacaine (2 or 8 mg/kg) or a combination of lidocaine (15 mg/kg) and epinephrine (3.8 microg/kg) perineurally; equal volumes of saline were administered as control treatments. Both axillary and dorsal approaches to the brachial plexus were evaluated. With the axillary approach, radial and ulnar compound nerve action potentials (CNAP), sensory nerve conduction velocities (SNCVs), and cord dorsum potentials (CDPs) were recorded after distal sensory nerve stimulation. Values were recorded before and at 5, 30, and 60 minutes after injection of local anesthetic or saline. Birds were monitored for the presence of a wing droop and a change in motor function on recovery from anesthesia. Results were highly variable for all techniques. No technique significantly decreased CDPs or resulted in consistent wing droop. Radial and ulnar CNAPs, SNCVs, and CDPs were consistently recorded in all birds. Variable results might indicate that the treatment, concentration, or volume of local anesthetic used was ineffective in producing local anesthesia. Electrodiagnostic methods used in these ducks to assess loss of sensory nerve conduction might not be sensitive enough to assess the effects of local anesthesia. Further research is needed to identify methods for assessing the efficacy of brachial plexus nerve blockade in birds.

An Electrocardiograph Artifact Caused by Peripheral Nerve Stimulation During an Interscalene Brachial Plexus Nerve Block

An Electrocardiograph Artifact Caused by Peripheral Nerve Stimulation During an Interscalene Brachial Plexus Nerve Block

Brachial plexus trauma: the morbidity of hemidiaphragmatic paralysis

Phrenic nerve palsy has previously been associated with brachial plexus root avulsion; severe unilateral phrenic nerve injury is not uncommonly associated with brachial plexus injury. Brachial plexus injuries can be...

Orthopaedic Management of the Upper Extremity of Stroke Patients

Cerebrovascular accidents often produce significant pathology, including upper extremity muscle contractures and deformities that may be painful and aesthetically unappealing and that interfere with activities of daily living and hygiene. Orthopaedic intervention may be required to manage these disabilities. Nonsurgical management includes brachial plexus and phenol nerve blocks, which provide temporary relief of painful contractures and allow for a period of spontaneous neurologic recovery of up to 6 months. Definitive surgical procedures should be avoided during this time. After this period, surgical management can be valuable in releasing muscle spasticity, managing painful contractures, and positioning the deformed extremity in a more functional and aesthetically appealing position. Current surgical management is directed at reducing or eliminating muscle spasticity and joint contractures, with the goal of correcting deformities in shoulder adduction, elbow flexion, forearm pronation, wrist and finger flexion, intrinsic muscle spasticity, thumb-in-palm deformity, wrist extension, and finger extension.