Brachial Plexus Block Research Articles

Comparison of combined suprascapular and axillary nerve pulsed radiofrequency and nerve block for the treatment of primary frozen shoulder: a prospective cohort study

Objectives To compare the effects of pulsed radiofrequency (PRF) and block of the suprascapular nerve (SSN) and axillary nerve (AN) in patients with primary frozen shoulder (FS). Methods Patients with primary FS received PRF (Group P) or block (Group B). Shoulder pain during rest, activity and sleep was measured by a numerical rating scale (NRS), the Shoulder Pain and Disability Index (SPADI) was used to assess shoulder function and disability, and the passive range of motion (PROM) of the shoulder joint was measured by a digital inclinometer. Assessments were made at baseline and 2 weeks and 1, 3, and 6 months after the procedure. Results Of the 74 patients, 63 were eventually included, and a total of 3 patients were lost to follow-up. Finally, 60 patients (30 in each group) completed the final analysis. There was a significant improvement in all outcome measures from baseline to 6 months after the procedure. Compared with those in group B, the NRS scores during activity and sleep in group P decreased more at 6 months after the procedure (p = 0.005 and 0.028). SPADI total scores were lower at 3 and 6 months after the procedure (p = 0.021 and 0.001). At different time after the procedure, most of the parameters of PROM improved more in group P than those in group B (flexion at 3 and 6 months, p = 0.042 and <0.001; abduction at 3 and 6 monthse, p = 0.001 and 0.001; extension at 3 and 6 months, p = 0.038 and 0.007, internal rotation at 6 months, p = 0.015; external rotation at 1, 3, and 6 months, p = 0.002, 0.002, and 0.001, respectively). Conclusions In patients with primary FS who completed both manipulation under anesthesia and intra-articular injections, PRF with SSN and AN appears to provide better pain relief, better PROM recovery, and more shoulder function improvement than nerve block treatment.

Levobupivacaine versus ropivacaine for brachial plexus block: A systematic review and meta-analysis of randomised controlled trials

Background and Aims: Brachial plexus block (BPB) is advantageous for elective orthopaedic or reconstructive upper limb surgery. However, the optimal local anaesthetic in BPB remains debatable. Therefore, we aim to investigate the efficacy and safety of levobupivacaine versus ropivacaine in BPB for upper limb surgery. Methods: A systematic review and meta-analysis synthesising randomised controlled trials (RCTs), retrieved by systematically searching PubMed, EMBASE, WOS, SCOPUS, Google Scholar, and CENTRAL since inception till June 2024. Continuous and dichotomous outcome variables were pooled using mean difference (MD) and risk ratio (RR), with a 95% confidence interval (CI), using Stata v. 17. We assessed heterogeneity using the Chi-square test and I2 statistic. Results: Sixteen RCTs and 939 patients were included. Levobupivacaine was significantly associated with a longer sensory block duration [MD: 1.66 (95% CI: 1.43, 1.89), P &lt; 0.001] and motor block duration [MD: 1.18 (95% CI: 0.11, 2.26), P = 0.03]. However, there was no difference between both groups in time to sensory block [MD: −0.30 (95% CI: −1.31, 0.71), P = 0.56], time to motor block [MD: −0.29 (95% CI: −1.26, 0.67), P = 0.55], pain score [MD: −0.48 (95% CI: −2.13, 1.16), P = 0.56], rescue analgesia rate [RR: 0.94 (95% CI: 0.74, 1.20), P = 0.64], and complications [RR: 0.47 (95% CI: 0.20, 1.13), P = 0.09]. Conclusions: Levobupivacaine is significantly associated with a longer duration of sensory and motor block in patients undergoing BPB for upper limb surgery compared to ropivacaine, with a similar safety profile. However, there was no difference regarding the time to onset of the sensory or motor block.

Anatomical variation in the relationship between brachial plexus and subclavian artery visualized on ultrasound while performing supraclavicular brachial plexus block

Anatomical variation in the relationship between brachial plexus and subclavian artery visualized on ultrasound while performing supraclavicular brachial plexus block

Method for Assessing the Degree of External Dislocation of the Catheter for Prolonged Brachial Plexus Block

Method for Assessing the Degree of External Dislocation of the Catheter for Prolonged Brachial Plexus Block

Impact of adding dexmedetomidine to various lidocaine concentrations in the interscalene brachial plexus block for upper limb surgery

Background. The interscalene brachial plexus block is widely used in orthopedic surgery for procedures on the proximal upper limb. However, the main concern remains the systemic toxicity of local anesthetics due to the use of their high concentrations. The purpose of the study was to investigate the effect of adding dexmedetomidine to lidocaine solutions of different concentrations in the interscalene brachial plexus block by examining the onset time and duration of motor block and analgesia. Materials and methods. The study included 75 patients who underwent elective upper limb surgery under interscalene brachial plexus block. They were divided into three groups (n = 25 each): control group I (L1%), group II (Dex L1%), and group III (Dex L0.5%). In group I, the brachial plexus block was performed using a 1% lidocaine solution with the addition of 50 mcg of epinephrine (1 : 400,000). In group II, 50 mcg of dexmedetomidine was added to the same solution, while group III (Dex L0.5%) used a 0.5% lidocaine solution combined with 50 mcg of dexmedetomidine. The duration of analgesia, motor function of the upper limb, hemodynamic changes, and side effects were assessed. Results. Preoperatively, the time of complete motor block onset (Me [25 %; 75 %]) in groups L1% and Dex L1% was 12.5 [10.0; 15.0] minutes, which was slightly shorter than in group Dex L0.5% (15.0 [15.0; 20.0] minutes; p = 0.06). The duration of complete motor block was longest in the Dex L1% group (330 [270; 440] minutes) compared to the Dex L0.5% group (305 [235; 348] minutes; p = 0.25) and the L1% group (185 [180; 255] minutes; p &lt; 0.002). The duration of analgesia in the Dex L1% group (460 [330; 480] minutes) was significantly longer than in the Dex L0.5% group (305 [248; 425] minutes; p = 0.35) and the L1% group (270 [210; 333] minutes; p = 0.018), with no statistically significant difference between Dex L0.5% and L1% groups (p = 0.29). The heart rate was significantly reduced at the start and the end of surgery compared to baseline in the Dex L1% and Dex L0.5% groups. Systolic blood pressure was significantly reduced in all groups at all stages compared to baseline. Conclusions. The addition of dexmedetomidine prolongs both motor block and analgesia after interscalene brachial plexus block and allows the lidocaine concentration to be reduced to 0.5 % without compromising efficacy.

Experimental implementation of the peripheral nerve block clinical registry: an observational study

Background and aimsPeripheral nerve block (PNB) is commonly used, but there is a lack of data on its effectiveness and safety in the clinic. Therefore, anesthesiologists have limited insight into how they are faring in terms of both safety and efficacy. Additionally, No PNB registry is recorded in IRAN. Herein, we reveal how a hospital might use information gathered in a hospital registry of PNB outcomes to guide future quality enhancement efforts.MethodThis was an observational, prospective, and unicenter study of all peripheral nerve blocks done in the operating room since December 22, 2022. After studying the data collected by the existing registries worldwide, the anesthesiology research center at Taleghani Hospital developed a questionnaire that incorporated the varying parameters set forth by earlier research and registries. Parameters were documented for each patient.ResultsA total of 105 patients, were accrued from December 22, 2022, to July 23, 2023. The brachial plexus blocks namely axillary, infraclavicular, and popliteal blocks were the most frequently used PNBs, respectively. The indications that generated the greatest demand for PNBs were upper limb fractures, I&amp;amp;D, and amputation, respectively. 82.9% of blocks were conducted while patients were sedated employing systemic administration of sedatives. In this registry, there were no deaths or complications with sequelae. The median duration of hospitalization following admission to the hospital was 3 days. The mean patient satisfaction score was 9.46 out of 10.ConclusionOur analysis demonstrates the effectiveness, safety, and feasibility of peripheral nerve blocks in preoperative anesthesia. It is recommended to continue the registry and conduct additional studies to enhance our understanding of this procedure.

Respiratory impact of local anaesthetic volume after an interscalene brachial plexus block with an extrafascial injection: a randomised controlled double-blinded trial.

We have previously demonstrated that an extrafascial injection of 20 ml of local anaesthetic for interscalene brachial plexus block (ISB) reduces the rate of hemidiaphragmatic paralysis by 70% compared with an intrafascial injection, with similar efficacy. In this double-blind trial, we tested the hypothesis that a local anaesthetic volume of 10 ml injected extrafascially would reduce the rate of hemidiaphragmatic paralysis vs a volume of 20 ml, while providing similar analgesia. Sixty ASA physical status 1-3 patients scheduled for elective shoulder surgery under general anaesthesia were randomised to receive ultrasound-guided extrafascial ISB using ropivacaine 0.75% 20 ml (control group) or 10 ml (low-volume group) injected lateral to the brachial plexus sheath. The primary outcome was incidence of hemidiaphragmatic paralysis (diaphragmatic excursion reduction of >75%), measured by M-mode ultrasonography, at 30 min after the procedure. Secondary outcomes included duration of analgesia and i.v. morphine consumption at 24 h after surgery. The 30-min hemidiaphragmatic paralysis rate was 80% (95% confidence interval [CI] 61-91%) in the control group and 19% (95% CI 8-40%) in the low-volume group (P<0.001). Participants in the low-volume vs control group had a shorter duration of analgesia (550 vs 873 min; P<0.01) and higher i.v. morphine consumption (20 vs 12 mg; P=0.03). A low volume of local anaesthetic injected extrafascially reduced the rate of hemidiaphragmatic paralysis, but at the expense of a shorter duration of analgesia compared with standard-dose extrafascial anaesthetic injection. NCT04726280.

Regional Anesthesia with Spontaneous Breathing for Trans-Axillary Surgery in Thoracic Outlet Syndrome: A Retrospective Comparative Study.

Background: Thoracic outlet syndrome (TOS) is an uncommon condition defined by the compression of neurovascular structures within the thoracic outlet. When conservative management strategies fail to alleviate symptoms, surgical decompression becomes necessary. The purpose of this study is to evaluate and compare the efficacy and safety of regional anesthesia (RA) using spontaneous breathing in contrast to general anesthesia (GA) for patients undergoing surgical intervention for TOS. Methods: We conducted a retrospective comparative study involving 68 patients who underwent trans-axillary first rib resection for TOS. The patient cohort was divided into two groups: 29 patients in the GA group and 39 patients in the RA group. The RA technique employed consisted of supraclavicular brachial plexus (SBP) and pectoral nerve (PECS II) blocks, accompanied by deep sedation. Key outcome measures such as pain scores, opioid consumption, and various perioperative parameters were systematically analyzed. Results: Postoperative pain levels recorded in the recovery room were significantly lower in the RA group, with a median numerical rating scale (NRS) score of zero compared to two in the GA group (p = 0.0443). Additionally, both intraoperative and postoperative opioid consumption showed a marked reduction in the RA group, with p-values of less than 0.001 and 0.0418, respectively. The RA approach was associated with shorter surgical durations (p = 0.0008), a decrease in the incidence of postoperative nausea and vomiting (PONV) (p = 0.0312), and a lower occurrence of intraoperative lung injuries (p < 0.0001). Furthermore, the length of hospital stay was significantly reduced for patients in the RA group. Conclusions: Although both groups reported low postoperative pain scores, the regional anesthesia approach exhibited distinct advantages in terms of opioid consumption, surgical duration, and overall perioperative outcomes. The utilization of SBP and PECS II blocks facilitated surgical procedures and mitigated complications, thereby positively influencing the postoperative recovery trajectory. Future prospective studies are essential to validate these findings further and to investigate long-term outcomes associated with the use of regional anesthesia in TOS surgery.

COMPARISON OF CLONIDINE AND DEXMEDETOMIDINE AS ADJUVANTS TO LEVOBUPIVACAINE FOR SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK IN UPPER LIMB SURGERY UNDER ULTRASOUND GUIDANCE

Objective: The addition of adjuvants to local anesthetics can significantly improve the efficacy of regional blocks. This study compares the effectiveness of Clonidine and Dexmedetomidine as adjuvants to Levobupivacaine in a supraclavicular brachial plexus block for upper limb surgeries. Methods: This observational comparative study included 68 patients divided into two groups to receive either Dexmedetomidine or Clonidine with Levobupivacaine. The onset and duration of the sensory block and the time to first rescue analgesia were evaluated. Results: Dexmedetomidine demonstrated a slightly faster onset and a significantly longer duration of sensory block and analgesia compared to Clonidine. Both drugs were well-tolerated without significant adverse effects. Conclusion: Dexmedetomidine surpasses Clonidine in prolonging the effects of Levobupivacaine in supraclavicular brachial plexus blocks, suggesting its advantageous use in clinical settings for extended analgesia.

COMPARISON OF CLONIDINE AND DEXMEDETOMIDINE AS ADJUVANTS TO LEVOBUPIVACAINE FOR SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK IN UPPER LIMB SURGERY UNDER ULTRASOUND GUIDANCE

Objective: The addition of adjuvants to local anesthetics can significantly improve the efficacy of regional blocks. This study compares the effectiveness of Clonidine and Dexmedetomidine as adjuvants to Levobupivacaine in a supraclavicular brachial plexus block for upper limb surgeries. Methods: This observational comparative study included 68 patients, divided into two groups to receive either Dexmedetomidine or Clonidine with Levobupivacaine. The onset and duration of the sensory block and the time to first rescue analgesia were evaluated. Results: Dexmedetomidine demonstrated a slightly faster onset and a significantly longer duration of sensory block and analgesia compared to Clonidine. Both drugs were well-tolerated without significant adverse effects. Conclusion: Dexmedetomidine surpasses Clonidine in prolonging the effects of Levobupivacaine in supraclavicular brachial plexus blocks, suggesting its advantageous use in clinical settings for extended analgesia.

Subcutaneous Pectoral Edema After Arthroscopic Labral Repair Despite Normal Irrigation Fluid Usage and Surgery Duration.

Edema after shoulder arthroscopic surgery poses concerns due to its potential complications such as compartment syndrome, nerve damage, and respiratory issues. This study aimed to investigate the acute accumulation of subcutaneous fluid after shoulder arthroscopy. A prospective cohort study, providing Level III evidence was conducted on 50 patients undergoing arthroscopic shoulder surgery under interscalene block anaesthesia from September to December 2023. The patients were divided into two groups: rotator cuff repair (RCR, n = 29) and labral repair for shoulder instability (LR, n = 21). Subcutaneous fluid levels were measured preoperatively, postoperatively, and at discharge (24 h postsurgery) using the MoistureMeterD Compact at the neck, pectoral region, deltoid area, cubital fossa, and carpal tunnel. Data on surgery duration and irrigation fluid volume were documented. In the statistical analysis, repeated measures ANOVA and the independent-samples t-test were applied to compare parametric data, while the Friedman test and Mann-Whitney U test were used for nonparametric data. The average operation time was 29.0 ± 12.1 min for RCR and 30.0 ± 10.9 min for LR, with average irrigation fluid use of 3.8 ± 0.9 and 4.0 ± 0.7 L, respectively (both p > 0.05). There was no increase in subcutaneous edema in the neck and deltoid region in both groups. At discharge, the percentage of subcutaneous fluid increased in the cubital fossa (p = 0.04 for RCR; p < 0.001 for LR) and carpal tunnel (both p < 0.001) in oth groups, whereas pectoral edema increased only in the labral repair group (p = 0.04). Subcutaneous pectoral edema can occur following arthroscopic labral repair, and increased fluid levels in the cubital fossa and carpal tunnel were observed in both rotator cuff and labral repairs, even in the absence of prolonged surgery or excessive irrigation fluid use. These findings highlight the need for careful postoperative management of edema after shoulder arthroscopy, particularly for labral repairs, with special attention to the pectoral region, cubital fossa, and carpal tunnel to prevent potential complications. The registry is sponsored by the United States National Library of Medicine (www. gov); Registry Name: Examination of Edema After Arthroscopic Shoulder Surgery ID: NCT06014203.

Optimizing Anesthetic Techniques: Special Brachial Plexus and Cutaneous Blocks in Clavicle Fracture Surgeries in Bangladesh

Background: This study compares the efficacy, safety, and resource utilization of brachial plexus + cutaneous nerve blocks (RAG) versus conventional anesthesia (CAG) in patients undergoing clavicle fracture surgeries. Methods: A total of 100 patients were enrolled and equally divided into the RAG (n=50) and CAG (n=50) groups. Baseline characteristics, intraoperative and postoperative outcomes, postoperative complications, length of hospital stay, and resource utilization were evaluated. Pain control was assessed using the Visual Analog Scale (VAS), and patient satisfaction was measured with a satisfaction score. Results: Baseline characteristics were comparable between the groups. Significant differences were observed in postoperative pain control, with the RAG group demonstrating lower VAS scores at all postoperative intervals (p &lt; 0.001). Patient satisfaction was significantly higher in the RAG group (9.5 ± 0.8 vs. 8.3 ± 1.3, p &lt; 0.001). Although no significant differences were found in respiratory depression, nausea, or wound infections, the RAG group showed trends toward reduced nausea and prolonged recovery. The RAG group also had a significantly shorter length of hospital stay (2.8 ± 0.7 days vs. 3.4 ± 1.0 days, p &lt; 0.01) and reduced supplemental analgesic use (20% vs. 50%, p &lt; 0.001). Ultrasonographic guidance was used in 80% of RAG cases. Conclusion: Brachial plexus and cutaneous nerve blocks provide superior postoperative pain control, greater patient satisfaction, and shorter recovery times compared to conventional anesthesia. These advantages, coupled with reduced reliance on supplemental analgesics, make regional anesthesia a more efficient and cost-effective option for clavicle fracture surgeries. Ultrasonographic guidance may further enhance the application of this technique in clinical practice.

Evaluating the Efficacy and Safety of a Multidrug Brachial Plexus Block Regimen Combining Lidocaine, Bupivacaine, and Dexamethasone for Major Upper Limb Surgeries in Bangladesh

Evaluating the Efficacy and Safety of a Multidrug Brachial Plexus Block Regimen Combining Lidocaine, Bupivacaine, and Dexamethasone for Major Upper Limb Surgeries in Bangladesh

Effects of different approaches of infraclavicular brachial plexus block on perfusion index and tissue perfusion.

Although both the lateral sagittal and costoclavicular approaches are applied at the cord level in the infraclavicular region, there is a major difference between the distributions of the two approaches. We aimed to investigate the effects of this different distribution on tissue perfusion and oxygenation. Sixty patients undergoing elective elbow, forearm, wrist and hand surgery under infraclavicular brachial plexus block were included in the study. Patients were divided into two groups: group CC (costoclavicular approach, n = 30) and group LS (lateral sagittal approach, n = 30). The primary outcomes of this study were increased perfusion index (PI) and tissue oxygen saturation (StO2) rate. Secondary outcomes were the duration of block application, sensory and motor block onset time, time to first analgesic need and duration of motor block. The PI and StO2 increased significantly from baseline to each time point in both groups; however, there were no significant differences between the groups. The time to reach the sensory block stage was shorter with the costoclavicular approach. The duration of block application was shorter when using the costoclavicular approach. There were no differences between the approaches in terms of the time to the first analgesic requirement or need for additional analgesics. The different distributions of the two different approaches to infraclavicular brachial plexus block, costoclavicular and lateral sagittal, did not have an additional effect on tissue perfusion and oxygenation. Both approaches can be preferred especially in surgeries in which an increase in tissue perfusion is desired owing to perfusion-enhancing properties. NCT04764591.

Comparing The Clinical Efficacy Of Intra Articular Shoulder Injection Verses Combined Suprascapular And Axillary Nerve Block For Adhesive Capsulitis

Objective: To evaluate the effectiveness of combined suprascapular nerve block with axillary nerve block and intra-articular steroid injection for the treatment of adhesive capsulitis. Study Design: Cross sectional study Place and Duration of the Study: Outpatient Department (OPD) of Ghurki Hospital from April 3, 2024, to September 5, 2024. Methodology: Patients in Group A were subjected to Ultrasound (USG) guided Selective Sensory Nerve Block (SSNB) in conjunction with Axillary Nerve Block (ANB), while patients in Group B received Intra-Articular (IA) methylprednisolone. Evaluations were conducted at baseline and at the 2nd, 4th, 6th, 8th, and 12th weeks post-intervention, utilizing the Visual Analog Scale (VAS), active and passive Range of Motion (ROM) of the shoulder, and the Shoulder Pain and Disability Index (SPADI). Statistical significance was assessed using Chi-square for qualitative variables and unpaired or paired t-tests for quantitative data. A p-value of less than 0.05 was considered indicative of statistical significance. Results: In this study of 80 participants, Group A showed significantly better outcomes than Group B over 12 weeks. Baseline pain scores were similar (7.50 ± 1.15 in Group A vs. 7.60 ± 1.20 in Group B, p=0.75), but by week 12, Group A's pain reduced to 2.60 ± 1.00 compared to 4.50 ± 1.20 in Group B (p&lt;0.001). Group A also had greater improvements in active and passive range of motion. For example, active abduction increased to 150.0 ± 10.0 degrees in Group A vs. 135.0 ± 11.0 degrees in Group B (p=0.003), and passive abduction to 160.0 ± 15.0 degrees vs. 135.0 ± 16.0 degrees (p&lt;0.0005). Overall, Group A had significantly better improvements in pain and mobility. Conclusion: The study concludes that IA steroid injection and combined SSNBwith ANB treat AC well. Long-term results are better with SSNB and ANB than steroid injections. Thus, SSNB and ANB can supplement exercise treatment and replace IAS if necessary. Keyword: Adhesive Capsulitis, Frozen shoulder, Suprascapular Nerve Block, Axillary Nerve Block, Intra-Articular Corticosteroid Injection, Treatment

Comparison of costoclavicular and lateral sagittal infraclavicular approaches in ultrasound-guided brachial plexus block.

Lateral sagittal infraclavicular approach is frequently used because it has less risk of complications and provides rapid and adequate regional anesthesia. Due to the fact that the brachial plexus is deeper in the infraclavicular region and the approach angle is sharper, it can be technically challenging. In this study, we aimed to compare the costoclavicular approach, which is a newly defined approach, with the lateral sagittal infraclavicular brachial plexus block. This prospective, randomized, single-blind study was conducted with a total of 43 patients. There were 21 patients in the lateral sagittal infraclavicular approach group (Group L) and 22 patients in the costoclavicular approach group (Group C). A mixture of 10 ml 1% lidocaine with 10 ml 0.25% bupivacaine was given to both groups under the guidance of ultrasonography. Sensory and motor examinations were performed every five minutes for 30 minutes, and the results were recorded. Sufficient block formation time was 10 (5-30) minutes in Group C and 15 (5-30) minutes in Group L (p=0.010). Sensory and motor block formation times of each nerve (median nerve, radial nerve, ulnar nerve, and musculocutaneous nerve) were found to be shorter in Group C than in Group L (p<0.05). The costoclavicular approach provides faster regional anesthesia formation than the lateral sagittal infraclavicular approach.

Comparison of Analgesia Efficacy between Magnesium Sulfate and Dexamethasone as an Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgery: A Prospective Randomized Study

Background: Brachial plexus block, a widely used technique, offers effective regional anesthesia and analgesia for upper extremity surgeries. Compared to general anesthesia, its increasing popularity can be attributed to its safety, efficacy, patient satisfaction, and reduced hospital stay. The use of adjuvants with local anesthetics enhances the quality and duration of analgesia. The aim of this study was to compare the clinical efficacy of dexamethasone to magnesium sulfate (MgSO4) as adjuvants to ropivacaine in patients undergoing supraclavicular brachial plexus block for upper limb surgery. Methods: In this prospective randomized study, 100 American Society of Anesthesiologists physical status I/II patients undergoing elective upper limb surgery under peripheral nervous system-guided supraclavicular brachial plexus block were randomized into two groups. Group RD (n = 50) received 8 mg dexamethasone + 0.75% ropivacaine (total volume 30 ml) and Group RM (n = 50) 200 mg MgSO4 + 0.75% ropivacaine (total volume 30 ml). Duration and quality of analgesia, onset, and duration of sensory and motor blocks were assessed. Results: Onset of sensory and motor block was significantly faster in Group RD (13.20 ± 1.93 and 17.44 ± 2.54 min) as compared to Group RM (15.88 ± 2.50 and 19.26 ± 2.54 min). Duration of sensory and motor block was also significantly longer in Group RD (1184.40 ± 111.96 and 1093.80 ± 91.56 min) as compared to Group RM (468.60 ± 62.07 and 385.80 ± 45.36 min). Duration of analgesia was prolonged in group RD (1211.12 ± 111.22) as compared to group RM (498.18 ± 64.44 min) (P &lt; 0.001). Proportion of those using two or more rescue analgesic dosages was significantly higher in Group RM (100%) as compared to that in Group RD (16%) (P &lt; 0.001). Conclusion: Dexamethasone outperformed MgSO4 as an adjuvant to ropivacaine during supraclavicular brachial plexus block.

A post-surgical neurological complication after upper limb surgery under interscalene block: A case report

A post-surgical neurological complication after upper limb surgery under interscalene block: A case report

Analysis of Onset of Sensory and Motor Blockade by using 0.5% Ropivacaine with that of 0.5% Bupivacaine in Supraclavicular Brachial Plexus Block

Analysis of Onset of Sensory and Motor Blockade by using 0.5% Ropivacaine with that of 0.5% Bupivacaine in Supraclavicular Brachial Plexus Block

Local anesthetic systemic toxicity after brachial plexus block with ropivacaine: a case report

The aim of this article is presentation of clinical case of local anesthetic systemic toxicity (LAST). Local anesthetic systemic toxicity is a rare but life-threatening complication. Ropivacaine is widely used for the regional blocks and rarely leads to the development of LAST. LAST may develop due to intravascular injection or high dose of ropivacaine. We present the case of 48-year-old-female (ASA I, 56 kg, and 165 cm), who underwent surgery on the right shoulder under brachial plexus block. Brachial plexus nerve block was performed by interscalene access with introduction of 40 ml of 0.75% ropivacaine (300 mg). Twenty minutes after the injection, complete sensory/motor block was achieved. Twenty-five minutes after the injection, the patient complained of numbness in the tongue, tinnitus and dizziness. During this time, her blood pressure was 132/83 mmHg, heart rate 82 beats/min. oxygen saturation 97%. No changes were observed on the ECG. Suspecting ropivacaine-induced toxicity, 50 mg of thiopental sodium followed by 2 mg of midazolam were administered for seizure prophylaxis, and supplemental oxygen was given via face mask. Patient’s state improved in 10 minutes. Ten minutes later 20% intralipid emulsion bolus during 2-3 min was administered followed by continuous infusion at a dose of0.25 ml/kg/min. Against clinical stablility and consciousness of the patient, decision was made to proceed with surgery, which was uneventful. Implementation of preventive measures can decrease the possibility for development of complication and emergency treatment can safe patient’s health and life. Preventive measures should include implementation of ultrasound nerve location guidance, individual calculation of local anesthetic dose, taking into account sex, weight, and physical status of a patient.