Effect Of Brachial Plexus Block Research Articles

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

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

The Effect of Brachial Plexus Block and Superficial Cervical Plexus Block Combined with General Anesthesia in Shoulder Arthroscopic Surgery

To investigate the effect of brachial plexus block and superficial cervical plexus block combined with general anesthesia in shoulder arthroscopic surgery is the objective of the study. 100 patients who underwent arthroscopic surgery in our hospital from March 2021 to March 2022 were randomly divided into observation group (n=50) and control group (n=50). General anesthesia was used in the control group and brachial plexus block and superficial cervical plexus block combined with general anesthesia was used in the observation group. The amount of analgesics and recovery, hemodynamics, pain and postoperative complications were compared between the two groups. The amount of analgesics used in the observation group was significantly less than that in the control group and the recovery time of the patients was shorter than that in the control group (p<0.05); the heart rate, and mean arterial pressure of the two groups at the time of skin incision (T1) were significantly different from those at the time of intubation (T0), 30 min (T2) after skin incision and 15 min (T3) after entering the anesthesia monitoring room after operation (all p<0.05). At T1, the heart rate of the observation group was lower than that of the control group and the map level was higher than that of the control group. The difference was statistically significant (p<0.05); the scores of visual analog scale and Ramsay sedation scale in the observation group at 2 h, 8 h and 24 h after operation were lower than those in the control group (p<0.05); there was no significant difference in the incidence of adverse reactions between the two groups (p>0.05). Brachial plexus block and superficial cervical plexus block combined with general anesthesia has a relatively good effect in shoulder arthroscopic surgery, which is conducive to scoring hemodynamics, reducing pain and good safety.

Retracted: Comparative Anesthesia Effect of Brachial Plexus Block Based on Smart Electronic Medical Ultrasound-Guided Positioning and Traditional Anatomical Positioning.

[This retracts the article DOI: 10.1155/2021/6676610.].

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

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

Outcome of Radiocephalic Arteriovenous Fistula Constructed Under Brachial Plexus Block Versus Local Anesthesia: A Randomized Controlled Trial

Backgrounds: Hemodialysis (HD) is the commonest modality of renal replacement therapy (RRT) which needs vascular access. Ideal vascular access should be well functional, durable, stable, and have fewer complications. An arteriovenous fistula (AVF) is the preferred form of vascular access and is recommended by Kidney Disease Improving Global Outcome (KDIGO) guidelines. Most of the AVFs are constructed under local anesthetic infiltration which has a high failure rate which is about 30-40% for radiocephalic arteriovenous fistula (RCAVF). This study aimed to change the anesthetic technique to brachial plexus block (BPB) for RCAVF creation to improve the primary patency rate and reduce early thrombotic complications. Objectives: The objective was to see the effect of brachial plexus block (BPB) on the outcome of AVF creation by primary patency rate, maturation time, primary functional patency rate, and complications. Materials and Method: This was a randomized controlled trial conducted in the Department of Urology, Bangabandhu Sheikh Mujib Medical University, Dhaka from December 2018 to December 2019. A total of 80 patients were selected from the study population according to inclusion and exclusion criteria. Then divided into two groups by simple random sampling. In the group, A RCAVF constructed under BPB, and group B RCAVF was constructed under LA. The standard operation technique of AVF construction was followed. Evaluation of AVFs was done at 3rd POD, 2nd week, 6th week, and 12th weeks to see the functional status and any complications. Doppler US was done at the 6th week routinely. Results: Among these 80 patients 3 patients were lost from the follow-up, two from group A and one from group B. There was no significant difference in age, sex, comorbidities, and HD status between the groups. There was higher primary patency in group A at 3rd POD and 2nd weeks but was not statistically significant. In the 6th week primary patency in group A was 33/38 (86.8%) and in group B 25/39(64.1%), p=0.033. In the 12th week, primary patency and functional primary patency rate were in group A was 33/38 (86.8%) and in group B 25/39(64.1%), p=0.033 and statistically significant. No significant difference in maturation time between the groups. Thrombosis was the most common complication, 14 in group B and 5 in group A. One BPB was failed but there was no significant complication related to BPB. Conclusion: Radiocephalic arteriovenous fistula constructed under brachial plexus block has better primary patency and functional primary patency than local anesthesia at 6th and 12th week. Early thrombotic complications were higher in AVF creation under local anesthetic infiltration. Anaesthesia with BPB can be used for primary radiocephalic AVF construction surgery to improve the outcome of RCAVF fistula and early complications. Bangladesh J. Urol. 2021; 24(2): 129-134

Prewarming for Prevention of Hypothermia in Older Patients Undergoing Hand Surgery Under Brachial Plexus Block.

BackgroundOlder patients are more vulnerable to inadvertent perioperative hypothermia. Prewarming contributes to the prevention of inadvertent perioperative hypothermia in patients under general or neuraxial anesthesia. However, the effects of brachial plexus block (BPB) on thermoregulation and the efficacy of prewarming in the prevention of hypothermia in older patients undergoing surgery with BPB remain unclear. This study evaluated the effects of BPB on thermoregulation and the efficacy of prewarming during BPB in older patients.MethodsPatients aged ≥65 years were randomly allocated to receive either standard preoperative insulation (control group, n=20) or preanesthetic forced-air warming for 20 minutes before BPB (prewarming group, n=20). During the perioperative period, tympanic temperatures were measured. Thermal comfort scores and shivering grades were also obtained.ResultsThe tympanic temperatures at the end of surgery did not differ between the groups (36.9°C±0.5°C and 37.0°C±0.4°C in the control and prewarming groups, respectively; p=0.252). The maximum temperature change was significantly lower in the prewarming group compared to the control group (0.36°C±0.4°C and 0.65°C±0.3°C, respectively; p=0.013). The hypothermia incidence and severity, thermal comfort scores, and shivering grades did not differ between the groups.ConclusionRegardless of the application of prewarming, BPB did not cause a clinically significant impairment of thermoregulation. Moreover, the efficacy of prewarming appeared to be low; thus, it may not be routinely required in patients undergoing orthopedic hand surgery under BPB.

Effect of Brachial Plexus Block on Tissue Oxygenation in Arteriovenous Fistula Surgery: A Randomized Clinical Trial

Effect of Brachial Plexus Block on Tissue Oxygenation in Arteriovenous Fistula Surgery: A Randomized Clinical Trial

Effects of different doses of dexamethasone as local anesthetic adjuvant on brachial plexus block: A protocol for systematic review and meta analysis.

Background:Dexamethasone has been widely used in brachial plexus block to enhance the effects of brachial plexus block. However, the clinical findings are not consistent with the dosage of dexamethasone prolonging local anesthetic nerve block. Therefore, the purpose of this study was to explore the effects of different doses of dexamethasone as local anesthetic adjuvant on brachial plexus block through network meta-analysis.Methods:We searched PubMed, Web of Science, Cochrane Library, and Embase databases to collect all randomized controlled trials (RCTs) of different doses of dexamethasone as local anesthetic adjuvant on brachial plexus block until March 2021. Two researchers then independently screened articles, extracted data, and evaluated the quality of selected literatures. All data was processed by Stata 14.0 and WinBUGS 1.4.3.software.Results:The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.Conclusion:Our study is expected to provide high-quality evidence-based medicine advice for the effects of different doses of dexamethasone as local anesthetic adjuvant on brachial plexus block.Ethics and dissemination:Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms.OSF REGISTRATION NUMBER:DOI 10.17605/OSF.IO/PZ5WR.

Comparative Anesthesia Effect of Brachial Plexus Block Based on Smart Electronic Medical Ultrasound-Guided Positioning and Traditional Anatomical Positioning.

With the intensification of population aging, the improvement of visualization technology, and the concept of accelerated rehabilitation surgery, the anesthesia method of upper extremity surgery is gradually changing. However, these methods are often caused by anatomical variations and often have low block success rates and patient satisfaction. The neuroanatomical position should be accurately located so that the puncture needle is right next to the nerve bundle or in the nerve sheath. This is very important for implementing accurate brachial plexus anesthesia. This article uses ultrasound-guided positioning technology and traditional anatomical positioning technology for brachial plexus block treatment, aiming to explore the anesthesia effect of brachial plexus block with different techniques. This article selects 120 patients undergoing brachial plexus block surgery for forearm or hand surgery and divides these 120 patients into 6 groups with 20 people in each group. The first 3 groups were treated with brachial plexus block using ultrasound-guided positioning technology. The latter 3 groups were treated with brachial plexus block using traditional anatomical positioning technology. Experiments proved that during anesthesia, compared with the ultrasound group, the heart rate of the traditional anatomy group was significantly decreased (P < 0.05), and the average arterial pressure of the six groups of patients at each time point had no statistical difference (P > 0.05). This shows that whether it is ultrasound-guided positioning technology or traditional anatomical positioning technology, it has no effect on the average arterial pressure of the patient at each time point. In addition to intuitive and accurate viewing of needle and nerve contact, ultrasound real-time guidance allows intuitive viewing of anesthesia. This is a special advantage of nerve block under ultrasound guidance.

Effect of brachial plexus block on the incidence of arterial hypotension and bradycardia events during shoulder arthroscopy in adolescents

Background. The role and significance of the technical aspects of interscalene brachial plexus block in the occurrence of sudden arterial hypotension and bradycardia events during shoulder arthroscopy in a semi-sitting position are ambiguous.&#x0D; Aim. The study aimed to assess the effect of interscalene brachial plexus block on the incidence of hypotension-bradycardia events during shoulder arthroscopic surgery in adolescents in a semi-sitting position.&#x0D; Materials and methods. This retrospective analysis of anesthesia protocols included 288 patients who underwent arthroscopic shoulder surgery in a semi-sitting position under the interscalene brachial plexus block. Regional blockades were performed with neurostimulation in Group 1 (n = 23), neurostimulation and ultrasound navigation without repositioning the needle in Group 2 (n = 70), and neurostimulation and ultrasound navigation with multiple precision repositioning the needle in Group 3 (n = 195).&#x0D; Results. Hypotension-bradycardia events were detected in 26 patients out of 288 (9%). There was a statistically significant difference in the frequency of hypotension-bradycardia in all groups: 10 (43.48%) in Group 1, 15 (21.43%) in Group 2, and 1 (0.51%) in Group 3 (p = 0.000). A direct correlation between hypotension-bradycardia episodes and local anesthetic volume (r = 0.405; p 0.05), and Horners syndrome (r = 0.684, p 0.05) was found.&#x0D; Conclusions. Interscalene brachial plexus block with a target delivery of low volume of local anesthetic and dual navigation reduces the risk of hypotension-bradycardia. Horners syndrome can be considered an early predictor of hypotension-bradycardia events.

Effect of Adding Ketamine as An Adjuvant to Lidocaine in Ultrasound Guided Supraclavicular Brachial Plexus Block

Background: Brachial plexus block is one of the most commonly used regional anesthetic techniques for postoperative analgesia. Its popularity originates in part from easily palpable landmarks and relative ease of placement. A number of adjuvants, such as ketamine, dexmedetomidine, and others have been studied to prolong the effect of supraclavicular brachial plexus block. Aim of the Work: Evaluation of the effect of adding Ketamine as an adjuvant to lidocaine in ultrasoung guided supraclavicular brachial plexus block. Patients and Methods: This randomized controlled study was conducted at the Department of Anesthesia, EL-Hussein Hospital, AL-Azhar university on 60 patients of ASA physical status I-II of either sex aged 18- 60 years. They were randomized into two equal groups 30 patients in each. Group A (Ketamine group): received 5 mg/kg lidocaine 2% and 2 mg/kg ketamine in a total volume 30 cc. Group B (Control group): received 5 mg/kg lidocaine 2% and saline in a total 30 cc. Results: the study showed a significant increase in mean control group compared to ketamine group according to postoperative VAS. Conclusion: Using of ultrasound led to decreasing the complications of supraclavicular brachial plexus block and adding ketamine as an adjuvant to lidocaine decreased the postoperative pain and the need for analgesics, without significant adverse effects. Therefore, it could be considered as an option to enhance the analgesic effects of the brachial plexus block.

Is the change of percutaneous oxygen pressure available to judge the effects of brachial plexus block?

To know the objective methods of the effects of the brachial plexus block, we studied the changes in percutaneous oxygen pressure (tcPO₂) with the hypothesis that tcPO₂ increases significantly on the blocked arm in comparison with the non-blocked arm, a phenomenon which is connected with vasodilation following the brachial plexus block. Fifteen patients scheduled for upper extremity surgery, aged 20 to 70 years, with ASA physical status I or II were included. Before anaesthesia, the electrodes used to measure tcPO₂ were put on the radial side of the forearm and upper arm of both the right and left sides (a total of 4 electrodes). Oxygen at 6 L min⁻¹ was administered by a facial mask. Once midazolam 1-2 mg and fentanyl 50 μg had been administered intravenously, a propofol infusion was started at a dose of 2 mg kg⁻¹ h⁻¹. The interscalene block was performed by means of a nerve stimulator, using 20 mL of 1% lidocaine solution combined with 20 mL of 0.75% ropivacaine solution. TcPO₂ was measured just before the block and 30 minutes after the block. TcPO₂ in both forearm and upper arm significantly increased after the block in both sides namely, blocked and non-blocked. No difference was observed in tcPO₂ between the blocked side and non-blocked side. Changes of tcPO₂ are not useful in order to assess the effects of the interscalene block under oxygen administration.

Nerve Blockage Attenuates Postoperative Inflammation in Hippocampus of Young Rat Model with Surgical Trauma.

It is hypothesized that central nervous system inflammation induced by systematic inflammation due to surgical trauma plays a critical role in postoperative cognitive dysfunction. The potential inhibitory effect of nerve blockage with local anesthetics on peripheral inflammatory response has been reported. We hypothesize that nerve blockage may be effective in reducing postoperative inflammation and cognitive decline. The rats at the age of 4 weeks were subjected to general anesthesia and humeral fracture fixation, in combination with brachial plexus block, saline versus ropivacaine, respectively. The rats from control group underwent general anesthesia only. The expression of proinflammatory cytokines in plasma and in hippocampus was measured. Open field test and new object recognition task were performed before surgery and on postoperative days (POD) 1, 3, and 7. Compared with control group, the level of cytokines in plasma and hippocampus revealed an obvious increase in surgery groups. The effect of brachial plexus block on decreasing cytokines was observed. The rats exposed to surgery without brachial plexus block showed behavior impairment. Our results indicated that nerve blockage could downregulate proinflammatory cytokines in hippocampus after humeral fixation surgery, which may ameliorate the postoperative cognitive dysfunction in young rats.

The clinical application of interscalene brachial plexus block independent on paresthesia: 327 cases reports

Objective To investigate the effect of brachial plexus block via Interscalene Route independent on paresthesia.Methods Three hundred and twenty seven patients undergoing collarbone,shoulder and upper limb surgery were collected.All patients received interscalene brachial plexus block independent on Paresthesia.The success of nerve block of nerve blocking was defined as the ability to complete surgery without the help of general anesthesia,or of droperidol-fentanyl.Results Paresthesia was not induced by brachial plexus block in all patients.Block success rate was 99.1％ (324 vs 327) and 3 failed(0.9％) in the studying patients.Conclusions Interscalene blocking independent on paresthesia is a simple and useful approach for surgery. Key words: Interscalene nerve block; Paresthesia

Effect of potentiated anesthesia of dexmedetomidine in patients with incomplete brachial plexus block

Objective To evaluate the effect of potentiated anesthesia of dexmedetomidine (DEX) when brachial plexus block were unsuccessful.Methods 42 patients with incomplete brachial plexus block were randomly divided into 2 groups(group A and group B,n=21).Sauteralgyl 25 mg and droperidol 2.5 mg were used in group A,0.8 μg/kg of DEX were used in group B within 10 min as a bolus,and 0.4 μg ·kg-1 ·h-1 of DEX were infused continuously until the end of the operation.Systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),transcutaneous oxygen saturation (SpO2),visual analogue scale (VAS),Ramsay score and other side effects were recorded before potentiated anesthesia (T0) and 5(T1),10(T2),30 min (T3) after potentiated anesthesia and end of operation(T4).Results Compared with group A,VAS were lower in group B[0(3.5) vs 3.5(3),0(1)vs 2(2.75),0(1) vs 2.5(3) at T1,T2,T4,respectively,P＜0.05].The Ramsay score in group B were higher than that of group A [(2.8±0.9) vs (1.8±0.9),(3.9±0.3) vs (2.8±0.9),(3.7±0.7) vs (2.7±0.9),(2.3±0.6) vs (1.3±0.8) at T1,T2,T3,T4,respectively,P＜0.01].There were no significant difference between two groups in other side effects such as hypotension,sinus bradycardia,nausea and vomiting(P＞0.05).There were no significant difference between two groups at each time point in SBP,DBP,HR and SpO2(P＞ 0.05),although there were significant difference among each group in SBP,DBP,HR(P＜0.01).Conclusions DEX can be used to strengthen the effect of brachial plexus block,with good analgesia and sedation,and high safety. Key words: Dexmedetomidine; Potentiated anesthesia; Brachial plexus; Nerve block

Usefulness of perfusion index to detect the effect of brachial plexus block

The traditional method to evaluate adequacy of the block for surgery is based on loss of sensory response to stimuli, which requires patient cooperation. Several methods have been described for objective assessment of the nerve block. The aim of the study was to investigate whether perfusion index (PI), a measure of peripheral perfusion from a pulse oximetry finger sensor, is a reliable and objective method for assessing the adequacy of infraclavicular blockade and to describe the time course of PI changes once peripheral nerve block has been achieved during surgery. The study was performed on patients scheduled for elective hand, wrist and forearm surgery under infraclavicular brachial plexus block. The pulse oximetry sensor was affixed to a finger ipsilateral to the side of the infraclavicular block for continuous measurement of PI. The average PI and the average percent change in PI from baseline, at 10, 20 and 30 min from the administration of the block were calculated. Baseline values of PI ranged from 0.6 to 4.7 % in 44 patients for whom infraclavicular block was effective and 1.8 to 2.4 % in 2 patients for whom infraclavicular block failed. Differences were not significant (p = 0.60). In the effective infraclavicular block group, PI rose continuously during the 30-min observation period. At 10 min, PI increased by (mean ± standard deviation) 120 ± 119 % from baseline. At 20 and 30 min, perfusion index increased by 133 ± 125 % and 155 ± 144 % from baseline. All changes from baseline were significant (p < 0.01). The perfusion index is a predictor of infraclavicular block success. The largest changes in PI occur 30 min after the block administration but significant changes in PI were detected 10 min after administration. Perfusion index monitoring may provide a highly valuable tool to quickly evaluate the success of regional anesthesia of the upper extremity in clinical practice.

Palpation- and ultrasound-guided brachial plexus blockade in Hispaniolan Amazon parrots (Amazona ventralis)

ObjectiveTo compare palpation-guided with ultrasound-guided brachial plexus blockade in Hispaniolan Amazon parrots. Study designProspective randomized experimental trial. AnimalsEighteen adult Hispaniolan Amazon parrots (Amazona ventralis) weighing 252–295 g. MethodsAfter induction of anesthesia with isoflurane, parrots received an injection of lidocaine (2 mg kg−1) in a total volume of 0.3 mL at the axillary region. The birds were randomly assigned to equal groups using either palpation or ultrasound as a guide for the brachial plexus block. Nerve evoked muscle potentials (NEMP) were used to monitor effectiveness of brachial plexus block. The palpation-guided group received the local anesthetic at the space between the pectoral muscle, triceps, and supracoracoideus aticimus muscle, at the insertion of the tendons of the caudal coracobrachial muscle, and the caudal scapulohumeral muscle. For the ultrasound-guided group, the brachial plexus and the adjacent vessels were located with B-mode ultrasonography using a 7–15 MHz linear probe. After location, an 8-5 MHz convex transducer was used to guide injections. General anesthesia was discontinued 20 minutes after lidocaine injection and the birds recovered in a padded cage. ResultsBoth techniques decreased the amplitude of NEMP. Statistically significant differences in NEMP amplitudes, were observed within the ultrasound-guided group at 5, 10, 15, and 20 minutes after injection and within the palpation-guided group at 10, 15, and 20 minutes after injection. There was no statistically significant difference between the two groups. No effect on motor function, muscle relaxation or wing droop was observed after brachial plexus block. Conclusions and clinical relevanceThe onset of the brachial plexus block tended to be faster when ultrasonography was used. Brachial plexus injection can be performed in Hispaniolan Amazon parrots and nerve evoked muscle potentials were useful to monitor the effects on nerve conduction in this avian species. Neither technique produced an effective block at the doses of lidocaine used and further study is necessary to develop a useful block for surgical analgesia.

Influence of the local anesthetics solutions’ temperature on muscular action potential amplitude decrease at brachial plexus block

Aim. To study influence of temperature of local anesthetics solutions on effectiveness of brachial plexus block using axillary access. Methods. Patients who underwent arm and hand surgeries were randomized either to the main group (n=25) or to the control group (n=25). In the main group, 1% lidocaine (20 ml) and 0.25% ropivacaine (40 ml - males, 30 ml - females) at 38 °C were used for brachial plexus block using axillary access. In the control group, anesthetics at room temperature were used. Brachial plexus block was performed using the axillary access at m. pectoralis major margin above the a. axillaris pulsation point. To register provoked muscular action potentials, a portative neurodiagnostic system «Nicolet One» was used. The percentage of provoked muscular action potential amplitude decrease was counted with results of a measurement before the block as a baseline. For additional analgesia and sedation phentanylum 0.005% was used until Ramsay sedation score II was achieved. «EZSAT-E» software package was used for data analysis. Results. In the main group brachial plexus block was achieved 14.2±3.4 minutes earlier than in the control group. Phentanylum dose required to provide psychic and emotional comfort was 45.4% lower in the main group (3.0±0.9 μg/kg per hour) compared to the control group (5.5±1.7 μg/kg per hour). Conclusion. The use of local anesthetics solutions at body temperature increases the efficiency of brachial plexus block and reduces the time of it’s achievement, increases it’s analgesic potential and decreases the need for narcotic analgesics to provide psychic and emotional comfort for the patient.

The Effects of Sympathectomy on Finger Photoplethysmography and Temperature Measurements in Healthy Subjects

Photoplethysmography uses light transmission to measure changes in tissue volume. The resulting photoplethysmogram is composed of AC and DC components. Limited data are available on the effects of vasodilation on the AC and the DC components of the photoplethysmograph signal. The aims of our study were (1) to investigate the effects of sympathectomy on different components of the photoplethysmogram, and (2) to compare sympathectomy-induced changes in the photoplethysmogram with changes in peripheral temperature. In 10 healthy subjects, sympathectomy-induced peripheral vasodilation was achieved using an axillary brachial plexus block. The nonblocked arm served as control. We obtained measurements of bilateral continuous measurements of finger blood volume (by photoplethysmography) and finger temperature. We separated the finger photoplethysmogram into its AC and DC components. In addition, we calculated the ratio of AC to DC (AC/DC). All data were recorded until 30 minutes after the end of brachial plexus block. Repeated-measures analysis of variance followed by the Dunnett post hoc test determined the effect of brachial plexus block on the finger photoplethysmogram and finger temperature. The DC component of the finger photoplethysmogram decreased (vasodilation) significantly (P < 0.0001) after brachial plexus block in the blocked arm starting 2.7 minutes after the block. Average decrease in DC values was -51% ± 19% (95% confidence interval: -61% to -42%) at 30 minutes after the block. None of the other photoplethysmogram components changed significantly from preblock baseline values. On average, the finger temperature increased significantly (P < 0.0001) starting 5.7 minutes after brachial plexus block in the blocked arm. Average increase in temperature was 7.1°C ± 3.8°C (95% confidence interval: 5.1°C-9.0°C) 30 minutes after the block. The DC component of the photoplethysmogram had the highest sensitivity and specificity to predict a successful block. This study characterizes sympathectomy-induced changes in the AC and DC components of the finger photoplethysmogram. In this experimental model, we found the DC component to be most sensitive in detecting peripheral vasodilation.

The analgesic effect of plexus anesthesia with buprenorphine in patients

To study the anesthetic effect of brachial plexus block by adding buprenorphine in local anesthetics and patients with intramuscular injection, and observe the anesthesia effects, the anesthesia maintenance time, postoperative analgesia effects. 60 cases of upper limb to line, hand surgery patients from Sep. 2009 to Dec. 2009 in Tianjin Hospital were randomly divided into 3 groups. A (local anesthetics without buprenorphine, n = 20); B group (plus 2 µg/kg buprenorphine in local anesthetics, n = 20); C group (intramuscular injection 2 µg/kg buprenorphine before anesthesia, n = 20). With B/BRAMN-STIMMPLEX-DIG nerve stimulator guided positioning of brachial plexus block of axillary line. 3 groups of patients recorded (1) the onset time of narcotic; (2) the duration of anesthesia; (3) the surgery time; (4) the pain score of postoperative 4, 8, 12, 24, 36, 48, 72 h; (5) the incidence of nausea and vomiting; (6) observed other side effects. the patients' age, weight, sex, operation time of the 3 groups had no significant difference between the comparison (P > 0.05); anesthesia onset time between the 3 groups showed no significant difference (P > 0.05). Duration of anesthesia: A, C group was significantly shorter than the B group (P < 0.01); pain score at 4 h, A and B, C no significant difference between groups (P > 0.05); 8, 12, 24 h, when group A was significantly higher than the B, C group (P < 0.01), 36, 48, 72 h when the A group and B, C no significant difference between groups (P > 0.05); the incidence of nausea A group 10%, B group 20%, C group 20%. Vomiting, the incidence of A, B group was 0, C group 30%. Buprenorphine adding local anesthetics in brachial plexus block or intramuscular injection buprenorphine before a block can be to achieve a satisfactory effect of postoperative analgesia, buprenorphine adding local anesthetics in brachial plexus block Narcotic maintenance of anesthesia time can be extended and have a significant effect and fewer adverse reactions.