Complete Sensory Block Research Articles

A COMPARISON OF ULTRASOUND-GUIDED SUPRACLAVICULAR VERSUS INFRACLAVICULAR BLOCKS FOR HAND AND FOREARM SURGERIES

Objective: Regional anesthesia, particularly techniques such as supraclavicular (SCB) and infraclavicular (ICB) blocks, is increasingly favored over general anesthesia for upper limb surgeries due to its safety and efficacy, especially with ultrasound guidance. Methods: A study was conducted at Silchar Medical College and Hospital involving 120 patients undergoing elective hand and forearm surgeries. These patients were randomly divided into SCB and ICB groups. Each block was performed using ultrasound guidance with an 8-MHz ultrasonic linear scanning probe. Patients received pre-medication, including pantoprazole/ranitidine, ondansetron, and midazolam (anxiolytic dose), 15 min before the procedure. The aim of our study was to compare the efficacy of ultrasound guidance in SCB block versus ICB block in terms of sensory and motor block, time taken to visualize structures, block performance time, and observe other parameters such as complications. Results: Significant differences were observed between the SCB and ICB groups in terms of systolic BP, diastolic BP, and mean arterial pressure (MAP). The SCB group exhibited a higher MAP, whereas the ICB group required more time for structure visualization and block performance. However, the ICB group achieved complete sensory blocks quicker than the SCB group. Needle advancements were more frequent in the SCB group as compared to the ICB group. Conclusion: The study concluded that while the ICB group had a longer block performance time, it experienced fewer complications, making ultrasound-guided ICB block a more effective option for upper limb surgeries compared to the SCB block.

A randomised trial comparing block characteristics of a mixture versus sequential injections of lignocaine and ropivacaine for supraclavicular brachial plexus nerve block in patients undergoing upper limb surgery.

There is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries. A double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications. Demographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications. Sequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration.

Comparison of three concentrations of ropivacaine in posterior quadratus lumborum block: A randomized clinical trial

BackgroundA conclusive evidence regarding the optimal concentration and volume of local anesthetic for quadratus lumborum block is lacking. MethodsIn this single-center, prospective, randomized, controlled study, 60 patients scheduled for laparoscopic colorectal surgery were randomly assigned to 3 different combinations of volume and concentration of ropivacaine (3 mg/kg) - Group 0.25%, Group 0.375% and Group 0.5%. All subjects received ultrasound-guided posterior quadratus lumborum block prior to the induction. The primary outcome was the complete sensory block rate of surgical site measured at 30 min after quadratus lumborum block, after extubation, at 12, 24, and 48 h after operation. Secondary outcomes were the changes in hemodynamic parameters before and after incision (ΔSBP, ΔDBP and ΔHR), postoperative pain score, the sufentanil consumption after surgery, length of stay and adverse reactions. ResultsThe sensory block rate of surgical site at 5 time points differed significantly among the three groups (P < 0.001). Both Group 0.375% (P < 0.001) and Group 0.5% (P < 0.001) had a higher sensory block rate than Group 0.25%, but no significant difference was observed between the former two. Group 0.375% and Group 0.5% had lower postoperative pain scores, lower sufentanil consumption after surgery and shorter length of stay. No statistical difference was observed in ΔSBP, ΔDBP, ΔHR and the incidence of adverse reactions. Conclusions0.375% and 0.5% ropivacaine in posterior quadratus lumborum block provide better sensory block of surgical site when compared to 0.25% in laparoscopic colorectal surgery. Trial registration numberChinese Clinical Trials Registry (ChiCTR2100043949).

Comparison of dexmedetomidine and fentanyl as adjuvants to intrathecal isobaric levobupivacaine in lower segment caesarean section

Background/Aim: Caesarean section is one the most common surgeries encountered in the operating room worldwide in the younger demo-graphic ages from 18-39 years of age. The objective of this study was to compare the efficacy of dexmedetomidine versus fentanyl as adjuvants to intrathecal levobupivacaine in the lower segment caesarean section. Methods: This quasi-experimental study was carried out at the Anaesthesia Department, Combined Military Hospital, Rawalpindi, Punjab, Pa-kistan from July 2021 to July 2023. A total of 240 patients were studied. They were divided into the dexmedetomidine group (n = 120) and fentanyl group (n = 120) group. Patients in both groups received 2.5 mL of 0.5 % of isobaric levobupivacaine with the dexmedetomidine group receiving 5 mcg of the drug and the fentanyl group 25 mcg of fentanyl to a total volume of 3 mL. Primary variables measured were: time to complete sensory and motor block, total duration of the block, time to first rescue analgesia after block regression in the post anaesthesia care unit (PACU) and mean PACU stay. Secondary variables observed were hypotension, nausea, vomiting and shivering. Results: The time on onset for a sensory block in the dexmedetomidine group was delayed compared to the fentanyl group (4.35 ± 0.14 min and 3.39 ± 0.11 min, respectively), (p &lt; 0.0001). The duration of the block was longer for the dexmedetomidine group with a mean time of 327.26 ± 12.60 min versus 243.3 ± 22.75 min (p &lt; 0.0001). When comparing the motor blockade, the time of onset to successfully reach Bromage score 3 was similarly delayed in the dexmedetomidine group with a mean time of onset of 3.33 ± 0.12 min versus 2.36 ± 0.09 min (p &lt; 0.0001). A similar trend was seen in the duration of the block with a mean time of 262.17 ± 13.31 min versus 203.34 ± 1.47 min (p &lt; 0.0001). Conclusion: Dexmedetomidine offered advantages over fentanyl as an adjunct to levobupivacaine spinal anaesthesia with a longer block duration and less adverse effects profile. It is recommended to use dexmedetomi-dine due to its better safety profile, longer duration and better hemodynamic stability. Fentanyl should be reserved when the early onset of the block is required in emergency cases.

A prospective randomized comparative study of analgesic effect of dexmedetomidine versus dexamethasone as an adjuvant to 0.75% ropivacaine in ultrasound-guided interscalene block

Abstract Background: Ultrasound (USG)-guided interscalene block (ISB) provides excellent anesthesia and analgesia for humerus surgery. Various adjuvants have been used to improve the quality of block and duration of analgesia. Aim: The aim of the study was to compare the efficacy of dexmedetomidine (DXM) and dexamethasone (DXA) as an adjuvant to 0.75% ropivacaine for interscalene brachial plexus block among patients undergoing humerus surgery. Settings and Design: The study design was a prospective randomized comparative study at a tertiary care teaching hospital. Materials and Methods: After ethical approval and CTRI registration, 52 patients of 18–60 years of age, American Society of Anesthesiology Grade I–II, scheduled for proximal and mid-shaft humerus surgery were randomly allocated in Groups A and B. Group A (n=26) received Ropivacaine 0.75% (20 ml) along with DXM 0.5 µg/ Kg and 2 ml saline (total 22 ml) and Group B (n=26) received Ropivacaine 075% along with DXA 8 mg (total 22 ml). ISB was performed with an in-plane technique using a linear probe. Duration of analgesia, block characteristics (onset, complete sensory, and motor block), and complications were recorded and compared for 24 h. Statistical Analysis: Data were statistically analyzed with Social Science Statistics. Student’s unpaired t-test and Chi-square tests were used, and all statistical tests were examined with P ≤ 0.05 level of significance. Results: The duration of analgesia in Group B was significantly longer than Group A (13 h 12 min ± 2 h 33 min–8 h 48 min ± 1 h 52 min, P &lt; 0.00001). The groups were comparable regarding block characteristics, baseline demographics, and intraoperative hemodynamic parameters. Conclusion: DXA as an adjuvant to ropivacaine provides analgesia for longer duration compared to DXM in USG-guided ISB.

Assessment of the learning curve of peribulbar blocks using the Learning-Curve Cumulative Sum Method (LC-CUSUM): an observational study

IntroductionThis study aimed to assess the learning curves of peribulbar anesthesia and estimate the number of blocks needed to attain proficiency. MethodsAnonymized records of sequential peribulbar blocks performed by first-year anesthesia residents were analyzed. The block sequential number and the outcomes were extracted from each record. Success was defined as a complete sensory and motor block of the eye, and failure was defined as an incomplete block requiring supplemental local anesthetic injections or general anesthesia. Learning curves using the LC-CUSUM method were constructed, aiming for acceptable and unacceptable failure rates of 10% and 20%, and 10% probability of type I and II errors. Simulations were used to determine the proficiency limit h0. Residents whose curves reached h0 were considered proficient. The Sequential Probability Ratio Test Cumulative Sum Method (SPRT-CUSUM) was used for follow-up. ResultsThirty-nine residents performed 2076 blocks (median = 52 blocks per resident; Interquartile Range (IQR) [range] = 27–78 [4–132]). Thirty residents (77%) achieved proficiency after a median of 13 blocks (13–24 [13–24]). ConclusionsThe LC-CUSUM is a robust method for detecting resident proficiency at peribulbar anesthesia, defined as success rates exceeding 90%. Accordingly, 13 to 24 supervised double-injection peribulbar blocks are needed to attain competence at peribulbar anesthesia.

Changes in Sensory Block Level During a Programmed Intermittent Epidural Bolus Regimen for Labor Analgesia: A Prospective Observational Cohort Study

(Can J Anesth/J Can Anesth. 2022;69:1471–1476) Currently, one of the most widely used methods of pain management is epidural analgesia, with drug delivery in a programmed intermittent epidural bolus (PIEB) in conjunction with patient-controlled epidural analgesia. Previously the investigators reported 2 sensory block levels associated with epidural analgesia: (1) upper sensory block level (USBL), the highest dermatome with any altered sensation to cold, and (2) lower sensory block level (LSBL), the highest dermatome with complete sensory block to cold. The purpose of this study was to further explore these sensory block levels and how they change over time with PIEB and patient-controlled epidural analgesia as a pain management method.

Levobupivacaine versus ropivacaine in patients undergoing lower abdominal surgeries

Regional anesthesia, like Peripheral nerve block, is commonly used for peripheral surgeries to reduce severe intraoperative and postoperative pain relief. .Some studies with levobupivacaine have shown that duration of analgesia of levobupivacaine are longer compared to that of an equivalent dose of bupivacaine or ropivacaine.This study is done to compare efficacy and safety of levobupivacaine with ropivacaine. In this study we tried to compare efficacy and clinical characteristics of isobaric forms of intrathecal levobupivacaine 0.5% and ropivacaine 0.75% in lower abdominal surgeries.This prospective, observational and open labeled, comparative study done for a period of one year in a tertiary care health centre, in South India, prior approval from Institutional ethics committee was taken. 60 patients were included and each of 60 patients was randomized (sealed, numbered and opaque envelopes) to one of two groups of 30 patients. Each of the patients enrolled in the study received one of two solutions: levobupivacaine or Ropivacaine, patient was turned supine immediately after injection, time of which was defined as ‘zero’. Thereafter, investigator, assessed upper and lower limits of sensory block (analgesia to pinprick), degree of motor block and recorded heart rate and arterial pressure. The patients were then transferred into the operating theatre and assessments were continued at 30 min intervals thereafter until complete motor and sensory blocks regression. Data were analysed using a standard computer-based statistics package.Mean time of onset of sensory blockade for levobupivacaine was 3.85±0.5 min and in Ropivacaine was 3.90 ± 0.6 min. Mean time of onset of motor blockade in levobupivacaine group was 3.65 ± 0.72 min and in Ropivacaine group was 3.82 ± 0.88 min, mean duration of motor blockade in Levobupivacaine group was 201.15±22.06 min and in Ropivacaine group was 204 ± 21.20 min. Mean time for regression for levobupivacaine was 98.27±10.18 min and for ropivacaine was 96.33 ±8.21min. There is no significant difference, Mean time for first request of analgesic for Levobupivacaine was 262.22 ±36.60 and for Ropivacaine was 261.20 ± 32.71 min. There is no statistically significant difference; there was no statistically significant difference in the incidence of adverse events in both the groups. So both the drugs are considered to be safe in spinal anesthesia.In conclusion, Ropivacaine and Levobupivacaine has similar onset of sensory and motor blockade with comparable hemodynamic parameters and time for rescue analgesic administration was comparable between two groups and incidence of post- operative complications is not significant with both drugs.

Comparison of the efficacy of 0.5% isobaric bupivacaine, 0.5% levobupivacaine, and 0.5% hyperbaric bupivacaine for spinal anesthesia in lower limb surgeries

Various advantages of isobaric bupivacaine, levobupivacaine, and hyperbaric bupivacaine are described. There are no studies reliably determining the benefits of these forms of bupivacaine. The purpose of the study was to compare the efficacy of spinal anesthesia (SA) performed with 0.5% isobaric bupivacaine, 0.5% levobupivacaine, and 0.5% hyperbaric bupivacaine. The clinical study was approved by the ethics committee. The sample size was calculated for a confidence level of 99%. 111 patients were randomly allocated into 3 equal groups for spinal anesthesia in lower limb surgeries. In group 1 (1B) spinal anesthesia was performed with 3 ml of 0.5% isobaric bupivacaine (n = 37); in group 2 (2L)—3 ml of 0.5% levobupivacaine (n = 37), in group 3 (3H)—3 ml of 0.5% hyperbaric bupivacaine (n = 37). The criterion for assessing the effectiveness of anesthesia was the need to switch to another type of anesthesia (criterion-no anesthesia), or the need for additional use of narcotic analgesics or local anesthesia during surgery (criterion-reporting of painful feelings during the operation). In 1B anesthesia efficiency by the criterion of additional intraoperative analgesia was 100% (37 patients; 95% CI [0.88–1.0]); 2L—86.4%; (31 patients; 95% CI [0.68–0.92]); 3H—72.9% (27 patients; 95% CI [0.56–0.84]). There were significant differences between groups 1B and 2L: p < 0.05 (p = 0.0104). There were no significant differences between groups 2L and 3H (p = 0.2587). All patients in group 1B developed complete sensory block (++) within 4 (3; 5) min. In group 2L complete sensory block developed in 34 patients (89.4%) within 9 (5; 14) min, in group 3H sensory block developed in all patients within 3 (2.5; 4). The duration of analgesia period between 1B and 2L did not statistically differ (p = 0.73). In 3H the duration of analgesia was 170 (150; 200) min. The study found 83.7% efficacy of levobupivacaine and 72.9% efficacy of hyperbaric bupivacaine in comparison with isobaric bupivacaine (100%) when administered intrathecally in equal volumes and amounts (by the criterion of additional intraoperative analgesia).Trial registration: NCT05184465 (Initial Release: 12/01/2021; date of first publication—11/01/2022).

Serratus Posterior Superior Intercostal Plane Block: A Technical Report on the Description of a Novel Periparavertebral Block for Thoracic Pain.

Background and objective We report a novel block technique aimed to provide thoracic analgesia: the serratus posterior superior intercostal plane (SPSIP) block. Design A cadaveric evaluation along with aretrospective case series evaluating the potential analgesic effect of the SPSIP block. This study included one unembalmed cadaver and five patients. Interventions Bilateral ultrasound-guided SPSIP block was used on cadavers with 30 mL of methylene blue 0.5% on each side; single-injection SPSIP blocks were used in patients. To measure results, dye spread was used in the cadaver, and dermatomal/pain score evaluation was used in patients. Main results Anatomical investigation in one unembalmed cadaver shows that its mechanism of action covers the rhomboid major muscle, erector spinae muscle, the deep fascia of the subscapularis/serratus anterior muscles, and intercostal nerves. In our patients, SPSIP resulted in an almost complete sensory block in the back of the neck, shoulder, and hemithorax. Conclusion Our cadaveric study shows extensive dye spread from C7 to T7. Patients who were administrated SPSIP block reported consistent dermatomal blockade from C3 to T10 levels of the hemitorax. The SPSIP block seems to be a safe, simple, and effective technique for thoracic analgesia.

Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine in Ultrasoundguided Supraclavicular Brachial Plexus Block: A Prospective Observational Study

Introduction: Upper limb surgeries are mostly performed under supraclavicular brachial plexus blocks which provide intraoperative and postoperative analgesia. Ultrasound provides clinicians with real-time images which are useful for better identification of the anatomical structures, safe needle placement, and adequate local anaesthetic spread. Adding adjuvants to local anaesthetic drugs prolong the duration of anaesthesia without concomitantly increasing the risk of complication. Aim: To compare fentanyl and dexmedetomidine when added as an adjuvant to ropivacaine for Ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: A prospective observational, doubleblinded study was conducted in the Department of Anaesthesia, at Government Medical College, Kottayam, Kerala, India, on 52 patients undergoing orthopaedic upper limb surgeries over a period of one year from April 2019-March 2020. Patients were divided into two groups of 26 subjects each. Group A received ropivacaine 0.5% (20 mL)+dexmedetomidine 1 mcg/kg and group B received ropivacaine 0.5% (20 mL)+Fentanyl 1 mcg/kg. Onset, time to complete sensory and motor block, duration of sensory and motor block, duration of analgesia, adverse effects and haemodynamic status were monitored. Statistical analysis was done using t-test and Chi-square test. Results: The demographic variables, onset of sensory and motor block were comparable in both the groups. Mean duration of sensory block in group A and B were 638.08±52.001 minutes and 568.85±36.478 minutes respectively. The mean duration of motor block in group A was 605.77±58.8 minutes and group B was 513.46±14.982 minutes. The mean duration of analgesia in group A and B were 722.3±58.13 and 615.00±48.19 minutes, respectively. Mean duration of sensory block, motor block and analgesia were found more in group A which was statistically significant with p-value=&lt;0.05. There was no significant difference in haemodynamic parameters. Conclusion: Dexmedetomidine was a better adjuvant to 0.5% ropivacaine as compared to fentanyl in Ultrasound-guided supraclavicular brachial plexus block in terms of duration of sensory block, motor block and analgesia.

Effect of Two Different Volumes of Ropivacaine and Lignocaine at Two Different Sites in Ultrasound-Guided Supraclavicular Brachial Plexus Block on Diaphragm Motility

Ultrasound (USG) guided supraclavicular brachial plexus block (BPB) helps in precise delivery of local anesthetic injection, reduced volume or dose of drug providing excellent surgical anesthesia with fewer complications. Objective of the study was to compare effect of two different volumes of Ropivacaine and Lignocaine at two different sites of USG-guided supraclavicular BPB on diaphragmatic motility, quality of block and tourniquet pain. A prospective randomized double-blinded comparative study was conducted among adult patient with below elbow elective surgery. In group A patients (n=17), 20ml of anesthetic solution was injected in the corner pocket and 10ml in the nerve cluster guided with USG. In group B patients (n=17), 15ml of the anesthetic solution was injected in the corner pocket and 5ml in the nerve cluster guided with USG. Hemodynamic parameters, diaphragmatic excursion, onset of anesthetic effects were measured at frequent intervals. The data were analyzed using Statistical Package for Social Sciences at P-value less than 0.05. Hemodynamic profile of the patients were similar in both groups (P-value&gt;0.05). Statistically significant hemi-diaphragmatic dysfunction (partial and complete paralysis) after 15 and 30minutes of blockade was more common in group A than Group B (P&lt;0.05). At 30 minutes after the injection of the anesthesia, all patient in both the groups had complete sensory and motor block in all nerve territory. Tourniquet time was lower in group A (80.35±9.59 minutes vs 84.12±7.75 minutes); however, it was statistically not significant (P-value&gt;0.05). The present study showed that the patients who received lesser half of the required volume of local anesthetics had less incidence of hemidiaphragmatic dysfunction with similar successful rate of blockage (100%) and similar quality of the block as compared to the patients who received greater half of the required volume of local anesthetics.

The Minimum Effective Analgesic Volume of 0.5% Bupivacaine for Ultrasound-Guided Anterior Suprascapular Nerve Block.

Objective The interscalene brachial plexus block (ISBB) constitutes the gold standard for analgesia after shoulder procedures. Ipsilateral phrenic nerve block remains the most common adverse effect after ISBB. Alternative nerve blocks are performed in shoulder surgery in order to prevent hemi-diaphragmatic paralysis (HDP). The purpose of the present study was to investigate the minimum effective local anesthetic volume of 0.5% bupivacaine for postoperative analgesia with an anterior suprascapular nerve block (ASSB). The secondary aim was to investigate diaphragm functions with the local anesthetic doses used while conducting effective volume research. Method This prospective observational study was conducted at the American Hospital of Istanbul, Turkey, from March to July 2022. The initial injected volume of 0.5% bupivacaine was 10 ml. Our clinical experience indicates that this yields a complete sensory block of the anterior suprascapular nerve. In accordance with the up-and-down method, the volume of 0.5% bupivacaine used for a particular patient was determined by the outcome of the preceding block, which represented block success. In case of effective ASSB being achieved, the volume of 0.5% bupivacaine to be administered to the next patient was lowered by 1 ml. In case of block failure, however, the volume of 0.5% bupivacaine to be applied in the subsequent case was increased by 1 ml. Ipsilateral hemi-diaphragmatic movement measurements were taken before (baseline) and 30 minutes after the block. General anesthesia was induced 60 minutes after the completion of the block performance by means of a standardized protocol. Results Sixty-seven patients were included in the study. The ED50 and ED95 calculated for anterior suprascapular nerve block using probit transformation and logistic regression analysis were 2.646 (95% CI, 0.877-2.890) and 3.043 ml (95% CI, 2.771-4.065), respectively. When complete paralysis was defined as 75% or above, partial paralysis as 25-50%, and no paralysis as 25% or less, volumes of 6 ml or lower appeared to cause no paralysis for the anterior suprascapular nerve block. Conclusion We, therefore, recommend using a volume of 6 ml or less in order to achieve diaphragm-sparing features for anterior suprascapular nerve blocks.

Motor-sparing peripatellar plexus block provides noninferior block duration and complete block area of the peripatellar region compared with femoral nerve block: a randomized, controlled, noninferiority study

BackgroundDeveloping adequate regional anaesthesia for knee surgeries without affecting lower limb mobilization is crucial to perioperative analgesia. However, reports in this regard are limited. We proposed a technique for ultrasound-guided peripatellar plexus (PP) block. Compared with the femoral nerve (FN) block, we hypothesized that this technique would provide a noninferior block duration and a complete cutaneous sensory block in the peripatellar region without affecting lower limb mobilization. An investigation was conducted to verify our hypothesis in cadavers and volunteers.MethodsThe study was designed in two parts. First, eight cadaveric lower limbs were dissected to verify the feasibility of PP block after methylene blue injection under ultrasound. Second, using a noninferiority study design, 50 healthy volunteers were randomized to receive either a PP block (PP group) or an FN block (FN group). The primary outcome was the duration of peripatellar cutaneous sensory block, with the prespecified noninferiority margin of -3.08 h; the secondary outcome was the area of peripatellar cutaneous sensory block; in addition, the number of complete anaesthesias of the incision line for total knee arthroplasty and the Bromage score 30 min after block were recorded.ResultsThe PP was successfully dyed, whereas the FN and saphenous nerve were unstained in all cadaveric limbs. The mean difference of the block duration between the two groups was − 1.24 (95% CI, -2.81 − 0.33) h, and the lower boundary of the two-sided 95% CI was higher than the prespecified noninferiority margin (Pnoninferiority = 0.023), confirming the noninferiority of our technique over FN block. The cutaneous sensory loss covered the entire peripatellar region in the PP group. PP block achieved complete anaesthesia of the incision line used for total knee arthroplasty and a Bromage score of 0 in 25 volunteers, which differed significantly from that of volunteers who underwent FN block.ConclusionUltrasound-guided PP block is a feasible technique. Compared with FN block, PP block provides noninferior block duration and complete blocking of the peripatellar region without affecting lower limb mobilization.Trial registrationThis study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2000041547, registration date 28/12/2020).

Efficacy Comparison of Magnesium Sulphate, Ketamine and Neostigmine Adjuvants to Bupivacaine 0.5% on Onset, Duration and Quality of Ultrasound-Guided Supraclavicular Block Characteristics for Forearm Surgery

Introduction: This study aimed to provide an evidence-based foundation for appraising the efficacy of magnesium sulphate, ketamine and neostigmine plus bupivacaine 0.5% on key supraclavicular block (SCB) characteristics made up of onset, duration and quality for forearm surgery. Materials and Methods: This double-blind trial enrolled ninety patients who were identified as having needed forearm surgery and been hospitalised in the Arak-based Valiasr Hospital, Iran, stratified participants into triad randomised groups receiving the aforementioned adjuvants. The basic requirements were met to incorporate the underneath groups' data to be recorded and analysed within SPSS release 20: (a) haemodynamic parameters (including mean arterial pressure/heart rate/oxygen saturation) documented at 5-min intervals until the end of surgery; (b) the onset and next to the duration of complete sensory and motor block, the time to administration of the patient's first post-operative analgesia and the overall dose of analgesic administered; (c) all block failures; (d) opioid consumption during post-operative 24 h and (e) pain score measured on a visual analogue scale throughout recovery time and scheduled post-operative times (2, 4, 8, 12 and 24 h). Results: Notwithstanding the shorter onset of sensory and motor block manifested in the magnesium sulphate group and longer duration of motor block in those receiving neostigmine regimen (P &lt; 0.001), the findings endorsed strong support for the potential efficacy of ketamine in affording the longer duration of sensory block, better clinically meaningful pain relief at all scheduled times and diminished opioid consumption during 24 h (all P &lt; 0.001). Conclusion: Bearing in mind the lack of complication needing to be thought of and the trial's clinical findings, which bespeak the shorter onset of the block (both sensory and motor) in the group receiving magnesium sulphate versus the longer duration of motor and sensory block in the neostigmine- and ketamine-treated groups, respectively, and diminished pain score and opioid consumption in the latter, all the adjuvants, thus, could be suggested to be contributed to achieving successful SCB in forearm fracture patients, depending on the patient's general condition and the anaesthesiologist's discretion.

Block duration is substantially longer with a liposomal suspension of bupivacaine than with 0.5% bupivacaine HCl potentiated with dexmedetomidine following an ultrasound-guided sciatic nerve block in Beagles

To compare the duration of bupivacaine liposome suspension in the dog with that of bupivacaine and dexmedetomidine following a perineural injection. 8 healthy Beagles. The left sciatic nerve of each dog was randomly assigned to an ultrasound-guided perineural injection with either bupivacaine liposome suspension (BLS) or with 0.5% bupivacaine with dexmedetomidine (1 µg/mL) (BUP-DEX). The contralateral nerve was assigned to the alternate agent. The sensory, motor, and proprioceptive functions were evaluated before the injection (baseline) and at 4, 10, 24, 48, 72, and 96 hours. The block in 1 limb in the BLS treatment appeared to have failed (data set excluded). The motor scores of 2 individuals could not be evaluated leaving 5 limbs to evaluate in the BLS treatment and 6 in the BUP-DEX. A total of 6 out of 7 limbs in the BLS achieved a complete sensory block. In 3 out of 5 treatments with BLS, motor block was only partial and in 2 not apparent at all. Proprioceptive block was partial in 5 out of 7 dogs in the BLS treatment. All functions were still completely obliterated at 10 hours in 6 cases in treatment BUP-DEX. All functions were restored in all cases by 96 and 24 hours after administration of BLS and BUP-DEX, respectively. The blockade characteristics of bupivacaine liposome suspension were effective and long lasting. Motor and proprioceptive deficits may be inconsistent over time.

Amiodarone Provides Long-Lasting Local Anesthesia and Analgesia in Open-State Mouse Nociceptors.

Local anesthetics with long-lasting effects and selectivity for nociceptors have been sought over the past decades. In this study, we investigated whether amiodarone, a multiple channel blocker, provides long-lasting local anesthesia and whether adding a TRPV1 channel activator selectively prolongs sensory anesthetic effects without prolonging motor blockade. Additionally, we examined whether amiodarone provides long-lasting analgesic effects against inflammatory pain without TRPV1 channel activator co-administration. In the sciatic nerve block model, 32 adult C57BL/6J mice received either bupivacaine, amiodarone with or without capsaicin (a TRPV1 agonist), or vehicle via peri-sciatic nerve injection. Sensory and motor blockade were assessed either by pinprick and toe spread tests, respectively. In another set of 16 mice, inflammatory pain was induced in the hind paw by zymosan injection, followed by administration of either amiodarone or vehicle. Mechanical and thermal sensitivity and paw thickness were assessed using the von Frey and Hargreaves tests, respectively. The possible cardiovascular and neurological side effects of local amiodarone injection were assessed in another set of 12 mice. In the sciatic nerve block model, amiodarone produced robust anesthesia, and the co-administration of TRPV1 agonist capsaicin prolonged the duration of sensory blockade, but not that of motor blockade [complete sensory block duration: 195.0 ± 9.8 min vs. 28.8 ± 1.3 min, F (2, 21) = 317.6, p < 0.01, complete motor block duration: 27.5 ± 1.6 min vs. 21.3 ± 2.3 min, F (2, 22) = 11.1, p = 0.0695]. In the zymosan-induced inflammatory pain model, low-dose amiodarone was effective in reversing the mechanical and thermal hypersensitivity not requiring capsaicin co-administration [50% withdrawal threshold at 8 h (g): 0.85 ± 0.09 vs. 0.25 ± 0.08, p < 0.01, withdrawal latency at 4 h (s) 8.5 ± 0.5 vs. 5.7 ± 1.4, p < 0.05]. Low-dose amiodarone did not affect zymosan-induced paw inflammation. Local amiodarone did not cause cardiovascular or central nervous system side effects. Amiodarone may have the potential to be a long-acting and nociceptor-selective local anesthetic and analgesic method acting over open-state large-pore channels.

Supraclavicular versus Infraclavicular Approach to Brachial Plexus Block under Ultrasound Guidance for Elective Surgeries of the Upper Limb: A Randomised Controlled Trial

Introduction: Ultrasonography has revived the infraclavicular approach to brachial plexus block resulting in many studies available in the literature. However, very few studies have assessed the sensory block characteristics of individual nerve territories by this approach. Aim: To compare the supraclavicular with the infraclavicular approach with special emphasis on the assessment of block characteristics of each nerve domain. Materials and Methods: This randomised controlled trial was conducted on 40 patients of American Society of Anesthesiologists (ASA) physical status I and II, aged between 20-60 years of age undergoing elective surgical procedures of the upper limb. They were randomly allocated into either group Supraclavicular (SC group) or Infraclavicular (IC group). Ultrasound-guided block was performed using 30 mL of 0.25% bupivacaine. The primary outcome measure was the efficacy of block, and the secondary outcome was the time taken for performance of block. Categorical variables were compared with the Chi-square test or Fisher’s-exact test. Continuous variables were analysed using the unpaired t-test. The p-value &lt;0.05 was considered significant. Results: Sensory block was complete in radial, median, and musculocutaneous nerve territories in both groups. All patients in the IC group had a complete sensory block in the ulnar nerve territory, compared to 80% patients in the SC group (p=0.036). Patients in the IC group had higher motor block scores in the shoulder joint (p=0.016), elbow, and wrist joints (p=0.036) and finger joints (p= 0.038). Block performance time was significantly longer in the IC group (p&lt;0.001). Conclusion: Infraclavicular approach provides better motor block and more complete sensory block of the upper limb. However, the time taken for performing the block was longer.

“A COMPARATIVE STUDY OF ULTRASOUND GUIDED TECHNIQUE VERSUS PERIPHERAL NERVE STIMULATOR GUIDED TECHNIQUE IN INFRA-CLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERIES.”

Background: Extensive use of ultrasonography for block execution has increased the success of procedure due to direct visualization of anatomical structures. Infra-clavicular brachial plexus block can be an attractive alternative to supraclavicular nerve block for upper limb surgeries. The objective of our study was to assess and compare the efcacy and success rate of USG guided technique versus PNS technique in Infra-clavicular brachial plexus block. Material And Methods: 70 adult patients with age in the range of 18-60 years, weight 50-80 Kg, ASA Grade I &amp; II posted for elective upper limb surgeries of hand, wrist, forearm and distal arm under infra-clavicular brachial plexus block. Group P (PNS)– Nerve stimulator guided Infraclavicular brachial plexus block. Group U (USG)– Ultrasound guided Infraclavicular brachial plexus block. Block execution time, sensory blockade, motor blockade and success rate were assessed. Assessment of sensory blockade was done by Hollmen scale whereas motor block assessment was done by Bromage Scale. Results: There was statistically signicant difference between the groups for block execution time, onset of sensory and motor blockade, time for complete sensory and motor block and success rate(p&lt;0.05). Conclusion: We conclude that, Ultrasound guided infraclavicular nerve block has shorter block execution time, faster sensory and motor block onset, signicantly earlier complete sensory and motor blockade, higher success rate with lesser pricks and minimal complications and should be preferred over PNS technique.

Perineural low dexamethasone dose as adjuvant in supraclavicular brachial plexus block for arteriovenous fistula creation in end stage renal disease: a randomized controlled trial

Background and aimsDexamethasone as adjunct to local anesthetic solution improves the quality of brachial plexus block (BPB). However, evidence for its efficacy at low doses (< 4 mg) is lacking. This study was designed to evaluate the duration of analgesia attained with low dose dexamethasone as adjuvant to local anesthetic for creation of arteriovenous fistula (AVF) under BPB. MethodsSixty-six patients scheduled for AVF creation were randomly allocated to receive either saline (control) or 2 mg dexamethasone, together with 0.5% ropivacaine and 0.2% lignocaine. The primary outcome was duration of analgesia, defined as time from performing the block to the first analgesic request. The secondary outcomes were time from injection to complete sensory block, time from injection to complete motor block, duration of motor block, postoperative analgesic consumption, and fistula patency at three months. ResultsAll the blocks were effective. In the group that received dexamethasone, the time to first analgesic request was significantly delayed (432 ± 43.8 minutes vs. 386.4 ± 40.2 minutes; p < 0.01). The onset of sensory and motor blockade occurred faster in dexamethasone group and overall analgesic consumption was also reduced. However, dexamethasone addition did not prolong the duration of motor block. There was no statistically significant difference in the patency of fistulas between the two groups at three months. (p = 0.34). ConclusionAddition of low-dose perineural dexamethasone to local anesthetic solution significantly prolonged the duration of analgesia. Further trials are warranted to compare the adverse effects between dexamethasone doses of 4 mg and lower.