Guided Interscalene Brachial Plexus Block Research Articles

To study the effectiveness of dexamethasone as an adjuvant with levobupivacaine 0.5% in USG guided interscalene brachial plexus block for shoulder surgeries

to study the effectiveness of dexamethasone as an adjuvant with levobupivacaine 0.5% in USG guided interscalene brachial plexus block for shoulder surgeries

Ultrasound guided interscalene brachial plexus block.

Peripheral nerve blocks have long been established as a crucial part of the enhanced recovery pathways after surgery. Interscalene brachial plexus block (ISB) is mainly indicated for anaesthesia and analgesia during shoulder and proximal arm surgery. Ultrasound technology has remarkably improved the efficacy and success rates of the ISB while limiting its potential complications.

EFFECT OF DEXAMETHASONE AS AN ADJUVANT TO BUPIVACAINE IN ULTRASOUND GUIDED INTERSCALENE BRACHIAL PLEXUS BLOCK IN UPPER ARM SURGERIES

Background:Ultrasound (US) in regional anaesthesia offers a new standard in nerve location and identification, allows real-time imaging of nerves and direct needle guidance.In present study we have access efficacy and safety of Dexamethasone as adjuvant to US guided Interscalene block for Upper arm surgeries. Aims:The study was conducted to compare the efficacy of Dexamethasone as an adjuvant to Bupivacaine in ultrasound guided interscalene brachial plexus block to provide intraoperative anaesthesia and postoperative analgesia in patients undergoing upper arm surgeries and to evaluate Hemodynamic Stability Methods:Present study was conducted at tertiary care hospital on 60 patients posted for elective upper arm surgeries, with ASA grade I and II, in age group of 18-70 years. The patients were randomly divided into 2 groups – Group A and Group B. All patients were given ultrasound guided interscalene block with 15 ml of 0.5% Plain Bupivacaine. Inj. Dexamethasone 8mg was added to local anaesthetic drug in Group A and 0.9% normal saline 2ml was added in Group B. All patients received 17 ml of volume of study drug perineurally. All blocks were successful to provide surgical anaesthesia and analgesia.Both the groups were evaluated for onset and duration of sensory and motor blockade, duration of analgesia, perioperative haemodynamic stability, total number of analgesic requests in 24 hours and any adverse reactions/complications. Results: Both the groups were comparable with respect to patient characteristics. In our study, Onset of sensory block was faster in Group A (3.866 ± 1.33 mins)compared to Group B (7.566 ± 1.67 mins) (p value <0.0001). Onset of motor block was faster in Group A (7.933mins) compared to Group B (11.733 mins) (p <0.0001). Duration of mean sensory block was longer in Group A (904 mins) compared to Group B (305.33mins)(p<0.0001).Duration of mean motor block was longer in Group A (861 mins) compared to Group B (264.33mins) (p< 0.0001). Mean Duration of analgesia was longer in Group A (1455.86 mins)compared to Group B (806.16 mins) (p<0.0001). Total number of analgesic requests was less in Group A (1.2 ) compared to Group B (2.37 ) (p <0.0001).Both groups showed perioperative haemodynamic stability. And no adverse reactions or complications were observed in any patient in Group A, whereas 2 patients (6.67%) in Group B had Postoperative Nausea Vomiting.

Comparison of ultrasound guided interscalene brachial plexus block using 0.2% ropivacaine with dexmedetomidine and 0.2% ropivacaine with dexamethasone - A prospective observational study

The Sri Lankan Journal of Anaesthesiology is the official journal of the College of Anaesthesiologists of Sri Lanka. It publishes clinical investigations, research articles, audits, case reports, review articles and CME articles relating to anaesthesiology, critical care and pain. It is published bi annually in January and June. Sri Lankan Journal of Anaesthesiology is included on DOAJ and Scopus.

Ultrasound guided interscalene brachial plexus block via lower approach for upper limb surgeries

Background: Brachial plexus block via interscalene approach is an excellent option for upper limb surgeries, but due to sparing of ulnar nerve (lower trunk, C8-T1) and its’ complications, it is not so popular. To overcome this problem, interscalene block via lower approach has been tried which has more advantage in view of ulnar nerve blockage and also less complications. In addition, ultrasound provides reliability, ease, rapidity and also patient comfort during block procedure. This prospective study was performed to evaluate the anaesthetic effect of lower approach interscalene block with the help of ultrasound and peripheral nerve stimulator.Methods: Ultrasound guided interscalene brachial plexus block via lower approach was given in randomly selected 30 patients, undergoing upper limb orthopaedic surgeries. After localisation of brachial plexus with ultrasound, the nerve roots were confirmed with the help of peripheral nerve stimulator, before injecting drug. At 5 and 15 min after block, all patients were assessed for the effect. Postoperatively they were assessed for any complication and also for their satisfaction level by Likert’s scale.Results: In territories of ulnar, radial and musculocutaneous nerve there was 100% effect while in median nerve territory 92.8% motor block was there. There was no need of analgesics during intra operative period in any patient and there were no major complications with this approach.Conclusions: Ultrasound guided interscalene block via lower approach is an excellent alternative for upper limb surgeries over classical approach in view of ulnar nerve blockage without any major complication.

Dexamethasone versus Ketorolac as Adjuvants to Interscalene Brachial Plexus Block in Shoulder Arthroscopy Under General Anesthesia

Abstract Background: The ultrasound guided Interscalene Brachial Plexus Block (IBPB) when used combined with general anesthesia has several advantages for patients scheduled for shoulder surgery. These advantages include, good control of intraoperative hemodynamics, and adequate management of postoperative pain.Aim and Objective: This study compares the effect of adding dexamethasone versus ketorolac to bupivacaine and lidocaine mixture in US guided IBPB regarding postoperative analgesia and intraoperative hemodynamics in patients under-going shoulder arthroscopy.Patients and Methods: This prospective randomized, controlled study was done in Assiut University Hospitals from February 2016 to January 2017. It was approved by Asyut University Ethics Committee, and a written informed consent was obtained from all patients. Sixty patients were enrolled in the study with the following inclusion criteria, ASA I-II, age 18-60 years, scheduled for elective shoulder arthroscopy in Asyut University Hospital. Patients were indiscriminately distributed to three groups: - Group [C] (control group) received 25ml solution: 10ml lidocaine 1%, 10ml bupivacaine 0.25% and 5mL of normal saline 0.9%. - Group [D] (dexamethasone group) received 25ml solution: 10ml lidocaine 1%, 10ml bupivacaine 0.25% and 5mL of dexamethasone (5mg). - Group [K] (Ketorolac group) received 25ml solution: 10ml lidocaine 1%, 10ml bupivacaine 0.25% and 5mL of ketorolac (10mg/ml) (50mg).Sensory and motor block onset in minutes, intensity of post-operative pain assessed by Visual Analogue Score (VAS), duration of post-operative analgesia, and intraoperative he-modynamics were documented and compared between the groups. Results: We founded that the duration of post-operative analgesia including the time for the first analgesic requirement was significantly longer in dexamethasone group with average 13.7±2 hours while it was 10.95±1.05 in ketorolac group and 11.7±3.53 in control group with. Total Rescue analgesia administration was much less in dexamethasone group in comparison with other groups but all groups did not need any additional opioid in the first day postoperative.Conclusion: Dexamethasone provides better post-operative pain relief than ketorolac when added to mixture of lidocaine and bupivacaine in ultrasound guided interscalene block for shoulder arthroscopy under general anesthesia.

A Critical Evaluation of an Effect of Nalbuphine as an Adjuvant to Bupivacaine for Ultrasound Guided Interscalene Brachial Plexus Block

A Critical Evaluation of an Effect of Nalbuphine as an Adjuvant to Bupivacaine for Ultrasound Guided Interscalene Brachial Plexus Block

Comparison of Two Different Volumes of Ropivacaine Used in Nerve Stimulator Guided Inter-scalene Block for Arthroscopic Shoulder Surgery - A Randomized Controlled Trial.

Background:This study was conducted to compare the analgesic efficacy of 10 ml versus 20 mL of 0.5% ropivacaine in nerve stimulator guided interscalene brachial plexus block, in patients undergoing arthroscopic shoulder surgery.Methods:A total of 70 American Society of Anesthesiologists physical status classes 1 and 2 patients, aged 18–65 years, undergoing unilateral arthroscopic shoulder surgery, were randomized into two groups. Group A received single shot inter-scalene block with 20 mL of 0.5% ropivacaine whereas Group B received the same with 10 mL. The primary outcome was difference in the total postoperative fentanyl consumption over 24 h. Secondary outcomes were difference in block onset, intra-operative hemodynamic parameters, intra-operative fentanyl consumption, duration of effective analgesia, visual analogue scale (VAS) scores at various time intervals, duration of motor block, and incidence of hemidiaphragmatic (HD) palsy.Results:Total 24 h fentanyl consumption was significantly higher in Group B (558 ± 112 mcg) compared to Group A (296 ± 88 μg). Block onset was slower in Group B than Group A. There was no difference in intra-operative fentanyl consumption. Postoperative VAS scores were significantly higher in Group B compared to Group A, at 6 h and thereafter. Duration of motor block was significantly shorter in Group B (6.25 ± 1.25 h) compared to Group A. HD palsy was seen in all the cases in both the groups.Conclusion:Single shot nerve stimulator guided interscalene block with 10 ml of 0.5% ropivacaine was inferior to 20 mL of 0.5% ropivacaine with respect to postoperative analgesic efficacy.

Comparative Evaluation of Magnesium as an Adjuvant To 0.5% Bupivacaine and 0.5% Ropivacaine In Ultrasound Guided Interscalene Brachial Plexus Block

Comparative Evaluation of Magnesium as an Adjuvant To 0.5% Bupivacaine and 0.5% Ropivacaine In Ultrasound Guided Interscalene Brachial Plexus Block

Ultrasound-guided interscalene nerve block vs procedural sedation by propofol and fentanyl for anterior shoulder dislocations

BackgroundFew studies were performed to compare ultrasound guided brachial plexus block with procedural sedation for reduction of shoulder dislocations in the Emergency Department (ED). This study was done to provide further evidence regarding this comparison. MethodsThis was a randomized clinical trial performed on patients presenting with anterior shoulder dislocations to the emergency department of an academic level 2 trauma center. Exclusion criteria were any contraindications to the drugs used, any patient which may not be potentially assigned into both groups because of an underlying medical condition, presence of neurovascular compromise related to the dislocation, presence of concomitant fractures, and patient refusal to participate in the study. Patients were randomly assigned into the Procedural Sedation and Analgesia (PSA) group with propofol and fentanyl or ultrasound guided Inter-Scalene Brachial Plexus Block (ISBPB) with lidocaine and epinephrine. ResultsA total of 60 patients (30 in each group) were included in the study. The emergency room length of stay was significantly lower in the ISBPB group, with mean (SD) values of 108.6 (42.1) vs. 80.2 (25.2) minutes (p=0.005). However, pain scores in the PSA group during reduction showed advantage over ISBPB [0.38 vs. 3.43 (p<0.001)]. Moreover, patient satisfaction was higher with PSA (p<0.001). ConclusionUsing ISBPB for reduction of anterior shoulder dislocations takes less time to discharge and may make it more feasible in conditions mandating faster discharge of the patient. However, since pain scores may be lower using PSA, this method may be preferred by many physicians in some other situations.

A Comparative Study between Conventional Technique and Ultrasound Guided Interscalene Brachial Plexus Block in Upper Limb Surgeries

A Comparative Study between Conventional Technique and Ultrasound Guided Interscalene Brachial Plexus Block in Upper Limb Surgeries

Efficacy of dexamethasone and dezocine combined with the ultrasound guided interscalene brachial plexus block

Objective To observe the clinical effect of dexamethasone combined with dezocine on the ultrasound guided interscalene brachial plexus block. Methods Accordance with the random number table, 80 patients with ASAⅠ~Ⅱ undergoing upper extremity operations were divided into four groups, with 20 cases in each group: group A was treated with 0.45% ropivacaine mesylate 20mL; group B was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg 20mL; group C was treated with 0.45% ropivacaine mesylate combined with dezocine 0.1mg/kg 20mL; group D was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg and dezocine 0.1mg/kg 20mL.The onset time, maximum block time, analgesia duration and the incidence of adverse reactions were recorded in the four groups. Results The onset time of group C and group D were faster than group A and group B[group C(3.65±0.88)min vs.group A(5.60±0.88)min, group B(5.35±0.81)min, t=7.303, 6.367, all P=0.000; group D(3.30±0.80)min vs.group A, group B, t=8.614, 7.678, all P=0.000], the maximum block time of group C and group D were faster than those of group A and group B[group C(8.45±1.19)min vs.group A(12.75±2.05)min, group B(12.65±1.90)min, t=8.583, 8.383, all P=0.000; group D(7.80±0.89)min vs.group A, group B, t=9.880, 9.680, all P=0.000]. The analgesia duration of the other groups were longer than those of group A[group B(430.50±30.86)min, group C(435.00±38.46)min, group D(534.50±46.73)min vs.group A(314.50±33.32)min, t=9.696, 10.072, 18.388, all P=0.000], group D was the best(group D vs.group B, group C, t=8.693, 8.317, all P=0.000), there were no significant differences between group B and group C(group C vs.group B, t=0.376, P=0.708). In the 80 patients, only one case of group C had postoperative nausea and vomiting symptoms, there were no significant differences between the groups(all P>0.05). Conclusion Dexamethasone combined with dezocine on the ultrasound guided interscalene brachial plexus block is a method with faster onset time, shorter maximum block time, longer analgesia duration, and it has less adverse reactions and better anesthetic effect, and it is more suitable for upper extremity operations. Key words: Neuromuscular blockade; Brachial plexus; Ultrasonography; Dexamethasone; Dezocine

Phrenic nerve block caused by interscalene brachial plexus block: breathing effects of different sites of injection

BackgroundInterscalene brachial plexus (ISB) block is often associated with phrenic nerve block and diaphragmatic paresis. The goal of our study was to test if the anterior or the posterior ultrasound guided approach of the ISB is associated with a lower incidence of phrenic nerve blocks and impaired lung function.MethodsThis was a prospective, randomized and single-blinded study of 84 patients scheduled for elective shoulder surgery who fullfilled the inclusion and exclusion critereria. Patients were randomized in two groups to receive either the anterior (n = 42) or the posterior (n = 42) approach for ISB. Clinical data were recorded. In both groups patients received ISB with a total injection volume of 15 ml of ropivacaine 1 %. Spirometry was conducted at baseline (T0) and 30 min (T30) after accomplishing the block.Changes in spirometrical variables between T0 and T30 were investigated by Wilcoxon signed-rank test for each puncture approach. The temporal difference between the posterior and the anterior puncture approach groups were again analyzed by the Wilcoxon-Mann-Whitney test.ResultsThe spirometric results showed a significant decrease in vital capacity, forced expiratory volume per second, and maximum nasal inspiratory breathing after the Interscalene brachial plexus block; indicating a phrenic nerve block (p <0.001, Wilcoxon signed-rank). A significant difference in the development of the spirometric parameters between the anterior and the posterior group could not be identified (Wilcoxon-Mann-Whitney test). Despite the changes in spirometry, no cases of dyspnea were reported.ConclusionA different site of injection (anterior or posterior) did not show an effect in reducing the cervical block spread of the local anesthetic and the incidence of phrenic nerve blocks during during ultrasound guided Interscalene brachial plexus block. Clinical breathing effects of phrenic nerve blocks are, however, usually well compensated, and subjective dyspnea did not occur in our patients.Trial registrationGerman Clinical Trials Register (DRKS number 00009908, registered 26 January 2016).

Delayed Horner′s syndrome following ultrasound- guided interscalene brachial plexus block

We describe a case of Horner's syndrome that occurred shortly after post-operative bolus administration of interscalene brachial plexus analgesia.

Evaluation of ultrasound guided interscalene brachial plexus block versus general anesthesia versus combination of both techniques in shoulder arthroscopy. A randomized clinical trial

Evaluation of ultrasound guided interscalene brachial plexus block versus general anesthesia versus combination of both techniques in shoulder arthroscopy. A randomized clinical trial

Ultrasound reduces the minimum effective local anaesthetic volume compared with peripheral nerve stimulation for interscalene block

BackgroundPrevious studies have demonstrated that lower local anaesthetic (LA) volumes can be used for ultrasound (US)-guided interscalene brachial plexus block (ISB). However, no study has examined whether US can reduce the volume required when compared with nerve stimulation (NS) for ISB. Our aim was to do this by comparing the minimum effective analgesic volumes (MEAVs). MethodsAfter ethics approval and informed consent, patients undergoing shoulder surgery were recruited to this randomized, double-blind, up–down sequential allocation study. The volume used for both US and NS was dependent upon the success or failure of the previous block. Success was defined as a verbal rating score of 0/10, 30 min after surgery. Ten needle passes were allowed before defaulting to the opposite group. Patients received general anaesthesia. Pain scores and analgesic consumption were assessed by a blinded observer. Statistical comparisons of continuous variables were performed using Student’s t-test and Mann–Whitney U-test as appropriate. Categorical variables were analysed using χ2 test. MEAV values were estimated using log-transformed up–down independent pairs analysis and probit regression. Significance was assumed at P<0.05 (two-sided). ResultsThe MEAV required to provide effective analgesia was significantly (P=0.034) reduced to 0.9 ml [95% confidence interval (CI) 0.3–2.8] in the US group from 5.4 ml (95% CI 3.4–8.6) in the NS group. Fewer needle passes were needed to identify the brachial plexus with US (1 vs 3; P<0.0001) and patients had less pain at 30 min after surgery (P=0.03). ConclusionsUS reduces the number of attempts, LA volume, and postoperative pain when compared with NS for ISB.

Ultrasound-Guided Low-Dose Interscalene Brachial Plexus Block Reduces the Incidence of Hemidiaphragmatic Paresis

Interscalene brachial plexus block is associated with 100% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether an ultrasound (US)-guided interscalene brachial plexus block performed at the level of root C7 versus a nerve stimulation interscalene brachial plexus block, both using 10 mL of ropivacaine 0.75%, resulted in a lower incidence of hemidiaphragmatic paresis. In a prospective randomized controlled trial, 30 patients scheduled for elective shoulder surgery under combined general anesthesia and interscalene brachial plexus block were included. Interscalene brachial plexus block using the same dose was performed using either US or nerve stimulation guidance of ropivacaine for both groups. General anesthesia was standardized. Ventilatory function was assessed using spirometry, and movement of the hemidiaphragm was assessed by US. Two patients in the US group showed complete paresis of the hemidiaphragm, but in the nerve stimulation group, 12 patients showed complete and 2 patients had partial paresis of the hemidiaphragm (13% versus 93%, respectively; P < 0.0001). Ventilatory function (forced expiratory volume at 1 second, forced vital capacity, and peak expiratory flow) was significantly reduced in the nerve stimulation group compared with the US-guided group (P < 0.05). One block failure occurred in the nerve stimulation group compared with none in the US group. No adverse effects occurred in either group. Ultrasound-guided interscalene brachial plexus block performed at the level of root C7 using 10 mL of ropivacaine 0.75% reduces the incidence of hemidiaphragmatic paresis.