Brachial Plexus Block Research Articles

Evaluation of needle to nerve interaction for neurological complications in ultrasound-guided interscalene brachial plexus blocks

BackgroundThe use of regional anesthesia techniques carries a well-known risk of perioperative neurological complications. The interscalene approach to brachial plexus block (ISB) is associated with the largest risk of neurological complications of any peripheral nerve block. The reported incidence of nerve injury after ISB varies, with estimates ranging from 0.5 % to 3 % of cases. In this prospective study, we sought to correlate the needle-to-nerve interaction during ISB procedures with the development of post-operative neurological outcomes. MethodsA novel grading system was developed to categorize various needle tip positions during ISB procedures. De-identified ultrasound recordings were graded post-procedure by two independent radiologists. These video grades were correlated with the incidence of post-procedural numbness or paresthesia and post-operative pain scores in the PACU and 24 hours postoperatively. Results108 patient videos were included for analysis. Zero videos received grade 1 (intraneural injection), 20 % received grade 2 (injection with needle against nerve root), 68 % received grade 3 (injection inside brachial plexus sheath), and 12 % received grade 4 (injection external to sheath). There was no statistical difference in terms of post-operative neurological complications or pain scores across the grades. Only four patients experienced post-operative neurologic complications on day one, and seven patients had neurological symptoms on day two. All symptoms resolved by post-operative day five. ConclusionsOur scoring system did not reveal relationship between more aggressive needling techniques and adverse post-procedural neurological symptoms. There was also no difference in pain scores across video grades, indicating that injection within the nerve sheath did not lead to better postoperative pain scores compared to injection outside the sheath. Since no procedures were found to be intraneural by the reviewing radiologists, no relationship between intraneural needling and adverse neurological outcomes could be elucidated. Larger studies in diverse settings may be required to capture greater variation in the block grades for more statistical power.

Retrospective evaluation of postoperative analgesia efficacy of a new technique in anterior iliac crest bone graft harvesting: anterior iliac block

BackgroundIn reconstructive surgeries, iliac crest bone graft harvesting is commonly preferred. The pain experienced after surgery at the anterior iliac crest (AIC) donor site might be more intense compared to the pain at the primary surgical area where the graft is placed. To address this issue, we defined a novel technique called the anterior iliac block (AIB), which can provide analgesia with lower volumes. In this study, the effect of this technique for AIC bone greft harvesting was evaluated.MethodsPatients who were operated on and had AIC bone graft harvested included in this retrospective study. The study collected age, height, weight, ASA classification, and duration of surgery, information on the regional anesthesia technique, block performance, postoperative pain severity, opioid consumption, rescue analgesics used in the first postoperative 24 h.ResultsData from 16 patients were analyzed. The popliteal sciatic block was performed in eight patients, infraclavicular brachial plexus block in four patients, supraclavicular brachial plexus block in one patient, PENG block in one patient, and proximal adductor canal block in two patients two provide analgesia for primary surgery. The median morphine consumption at postoperative 24th hour was 3.5 mg, median NRS score was 1 at postoperative 1st hour, and 0 at postoperative 6th, 12th and 24th hours.ConclusionsThe study findings indicate that the AIB provides adequate analgesia for AIC graft harvesting in the first postoperative 24-hour period. It can be used as an adjuvant to the peripheric nerve block for the primary surgical site.Trial registrationNCT06295224.

Clinical value of esketamine combined with ropivacaine in rebound pain after brachial plexus block in patients with upper limb fractures

ObjectiveTo analyze the clinical value of the combination of esketamine and ropivacaine in alleviating rebound pain in patients with upper limb fractures following brachial plexus block.MethodsA total of 149 patients with unilateral upper limb fractures who underwent open reduction and internal fixation surgery under brachial plexus block anesthesia from November 2021 to August 2022 were selected as the subjects for the study and randomly divided into the esketamine group (RNK group) and the ropivacaine group (R group). The incidence of rebound pain at 48 h postoperatively, intraoperative mean arterial pressure (MAP) and heart rate (HR), the onset time and duration of blockade, the Numeric Rating Scale (NRS) scores for pain at rest and with activity during the perioperative period, the dosage, numbers of compressions, and effective compressions of postoperative patient-controlled analgesia with sufentanil, and occurrence of adverse reactions were assessed and compared between the two groups.ResultsThe incidence of rebound pain in the RNK group was lower than that in the R group (P < 0.05). The RNK group exhibited higher MAP and HR at 5 min and 10 min after anesthesia compared to the R group (P < 0.05). The RNK group had faster onset time and longer duration of sensory and motor blockade compared to the R group (P < 0.05). The NRS scores at rest and with activity at 12 h and 24 h postoperatively in the RNK group were lower than those in the R group (P < 0.05). The total numbers of compressions, effective numbers of compressions, and dosage of sufentanil postoperatively were lower in the RNK group compared to the R group (P < 0.05). The incidence of adverse reactions in the RNK group did not differ significantly from that in the R group (P > 0.05).ConclusionsThe combination of esketamine and ropivacaine demonstrates a favorable preventive effect on rebound pain in patients with upper limb fractures following brachial plexus block, which is conducive to reducing the incidence of rebound pain, shortening the onset time of blockade, and prolonging the duration of blockade.Clinical Trial RegistrationClinicalTrials.gov, identifier (ChiCTR2100053035).

A comparative study of 0.5% ropivacaine versus 0.5% ropivacaine with dexamethasone on postoperative pain in interscalene brachial plexus block for shoulder surgery

A comparative study of 0.5% ropivacaine versus 0.5% ropivacaine with dexamethasone on postoperative pain in interscalene brachial plexus block for shoulder surgery

A COMPARISON OF 0.5% BUPIVACAINE ALONE VERSUS 0.5% BUPIVACAINE WITH VERAPAMIL AS AN ADJUNCT IN ULTRASOUND-GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Objective: Supraclavicular brachial plexus blocks are commonly performed for surgeries on the upper limb because they are highly effective for both anesthesia during the procedure and pain control afterward. This method targets the entire brachial plexus, making it a popular alternative to general anesthesia, as it minimizes associated risks while offering better pain relief after the surgery. Bupivacaine, a long-lasting local anesthetic, is often preferred for this block, though its pain-relieving effects eventually wear off. Owing to limitations regarding the duration of analgesia, many adjuncts have been tried since time immemorial to enhance the effectiveness of the blocking properties of these local anesthetics. Verapamil, a calcium channel blocker, has emerged as a promising adjunct that can potentially enhance and prolong the effects of Bupivacaine. This study aims to compare the efficacy of 0.5% Bupivacaine alone versus Bupivacaine combined with Verapamil in ultrasound-guided supraclavicular brachial plexus blocks. Methods: A randomized clinical trial was conducted on patients undergoing elective upper limb surgeries under ultrasound-guided supraclavicular brachial plexus block. Group A received 30 mL of 0.5% Bupivacaine, whereas Group B received 30 mL of 0.5% Bupivacaine with 5 mg of Verapamil. Primary outcomes included the time of onset of sensory and motor blockade and the duration of analgesia for the same, whereas secondary outcomes included post-operative pain scores and hemodynamic stability. Results: The addition of Verapamil to Bupivacaine significantly accelerated the onset of sensory and motor blockade in Group B compared to Group A. Group B also exhibited a significantly prolonged duration of both sensory and motor blockade and reduced post-operative analgesic requirements. Conclusion: Verapamil helps boost the effectiveness of Bupivacaine in supraclavicular brachial plexus blocks, speeding up the onset of its actions and extending its pain-relieving effects. This makes it a useful addition to local anesthetics, making it a valuable adjunct in regional anesthesia.

COMPARISON OF ANESTHETIC EFFECT OF PLAIN ROPIVACAINE VERSUS DEXMEDETOMIDINE AS AN ADJUVANT TO ROPIVACAINE IN USG-GUIDED SUPRACLAVICULAR BLOCK FOR UPPER LIMB SURGERIES

Objectives: Perioperative pain management is very important to achieve patient satisfaction. The objectives of the current study were to compare the anesthetic effects of dexmedetomidine and plain ropivacaine as an adjuvant to ropivacaine for upper limb surgeries in the supraclavicular brachial plexus block in terms of hemodynamic responses, quality, onset, and duration of sensory and motor block, post-operative pain management and side effects/complications if any. Methods: Sixty adult patients scheduled for upper limb surgeries were randomized into Group A and Group B of 30 patients each. Patients in Group A received 0.5% Ropivacaine 20 mL+5 mL normal saline and Group B received 0.5% ropivacaine 20 mL+0.5 mL (50 μg) dexmedetomidine+4.5 mL normal saline. The primary objective of our study was to compare the groups in terms of quality of block, onset, and duration of sensory and motor block and post-operative pain management. The secondary objective was to compare the intraoperative hemodynamic changes and post-operative adverse effects. Results: Time taken in the onset of the sensory as well as motor block in both the groups was statistically significantly more in Group A compared to Group B. The duration of the sensory as well as the motor block was much higher in Group B compared to Group A with a statistically significant difference. The total duration of analgesia was slightly higher in Group A compared to Group B. The mean numerical rating scale was significantly lower in Group B compared to Group A at all-time intervals till 24 h. No major side effects were observed with study drugs. Conclusion: The study confirmed that dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block hastens the onset of the sensory as well as motor block and prolongs the duration of the sensory as well as the motor block in the upper limb surgeries.

Ultrasound assessment of the frequency and variation of arteries in the interscalene region.

Given the abundance of arteries in the neck, a significant risk of puncturing arteries exists when performing a brachial plexus block. Therefore, it is important to confirm the presence of arteries when performing a brachial plexus block via the interscalene approach. This study aimed to investigate the frequency and variations of arteries in the interscalene region in healthy Japanese adults using ultrasonography. This is an observational study at a university hospital. We analyzed videos of the brachial plexus recorded in another study using an ultrasound device and then investigated the frequency of the presence of arteries and the location of arteries in the interscalene region. Among 68 cases, 48 (70.6%) had one or more arteries in the interscalene region (63 arteries in total). The artery frequency on the ventral side of the 5th cervical nerve (C5), between C5 and the 6th cervical nerve (C6), between C6 and the 7th cervical nerve (C7), between C7 and the 8th cervical nerve (C8), and on the dorsal side of C8 was 19.1%, 1.5%, 35.3%, 29.4%, and 7.4%, respectively. The artery frequencies between C6 and C7 and between C7 and C8 were higher than those between C5 and C6 and on the dorsal side of C8. Interscalene observations using ultrasound devices revealed a high artery frequency, with numerous topographic variations.

Randomized Clinical Trial Comparing Mixed Liposomal Bupivacaine versus Continuous Catheter for Interscalene Block during Shoulder Arthroplasty: A Comparison of Analgesia, Patient Experience, and Cost

BackgroundContinuous interscalene catheters extend analgesia beyond 24 hours but are resource-intensive, while the efficacy of liposomal bupivacaine for single-injection interscalene blocks remains uncertain. The purpose of this investigation was to examine the analgesic efficacy, quality of recovery, and treatment costs between interscalene nerve block using either an indwelling catheter or single shot block using liposomal bupivacaine, in patients undergoing shoulder arthroplasty. MethodsIn this single-center, parallel, unblinded, randomized clinical trial, 83 patients undergoing primary shoulder arthroplasty were assigned to either a continuous interscalene catheter group (n=44) or a single-injection liposomal bupivacaine interscalene block group (n=39). The interscalene catheter group received a 15-20 mL bolus of 0.5% bupivacaine HCl followed by continuous infusion at 8 mL/h for 69 hours. The single-injection interscalene group received 10 mL (133 mg) liposomal bupivacaine with 5 mL of 0.5% bupivacaine HCl. The primary outcome was pain at rest 24 hours post-surgery. Secondary outcomes included pain scores, opioid consumption, complications, quality of recovery, and a time-driven activity-based cost analysis through postoperative day 3. ResultsThere was no significant difference in median pain scores at 24 hours between the continuous interscalene catheter group and the single-injection liposomal bupivacaine group (1.0 [0.0, 2.0] vs. 1.0 [0.0, 3.0]; P=0.433). Comparable analgesia was observed through postoperative day 3, with no differences in opioid consumption or quality of recovery. No serious adverse events were reported; however, 16% of patients in the continuous catheter group experienced dislodgement or leakage. Liposomal bupivacaine was associated with a 28% reduction in costs compared to the continuous catheter approach. ConclusionSingle-injection interscalene block with liposomal bupivacaine provides comparable analgesia to continuous interscalene catheters through postoperative day 3 while offering better value in the perioperative management of shoulder arthroplasty patients.

Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial

BackgroundRebound pain is believed to involve both nociceptive pain due to insufficient analgesia and hyperalgesia induced by regional anesthesia. Adjuvant's addition could prevent rebound pain. This study aimed to determine if the addition of dexamethasone or clonidine to local anesthetic when performing interscalene block could prevent rebound pain. MethodsThis was a multicenter, prospective, parallel grouping, randomized clinical trial conducted with patients receiving a single injection of bupivacaine 0.375% in interscalene block ultrasound guided and general anesthesia for shoulder surgery were randomly assigned to either no additives (control), clonidine (30 mcg), or dexamethasone (4 mg). The primary outcome was rebound pain, defined as sudden onset of pain, moderate to severe intensity (VAS ≥7) without improvement with oral medication, followed by VAS pain at rest, required rescue analgesia, the occurrence of adverse events or complications, and satisfaction survey assessments between groups. Rebound pain and pain at rest were assessed 2, 4, 6, 12, 24, and 48 hours after the procedure. ResultsThe incidence of rebound pain was not statistically different between groups (p-value = 0.22), with an observed incidence of 41.2% (95% CI 25.9‒57.9), 28.6% (95% CI 16.7‒43.3), and 23.3% (95% CI 12.6‒37.6) in the control, dexamethasone, and clonidine groups, respectively. Additionally, there were no significant differences between the groups in time, from anesthetic blockade to first complaint of pain or the severity of postoperative pain. ConclusionThe administration of dexamethasone or clonidine as perineural adjuncts to local anesthesia in single-injection interscalene blocks did not significantly reduce the incidence of rebound pain.

Comparative study between fentanyl and dexmedetomidine as adjuvant to ropivacaine in supraclavicular brachial plexus block: A prospective and randomized study

Comparative study between fentanyl and dexmedetomidine as adjuvant to ropivacaine in supraclavicular brachial plexus block: A prospective and randomized study

Comparison of Opioid Sparing Effect of Liposomal versus Non-Liposomal Bupivacaine for Interscalene Block in Total Shoulder Arthroplasty: A Randomized Controlled Trial

Comparison of Opioid Sparing Effect of Liposomal versus Non-Liposomal Bupivacaine for Interscalene Block in Total Shoulder Arthroplasty: A Randomized Controlled Trial

The effect of anesthesia methods on the neutrophil-lymphocyte ratio in patients undergoing forearm surgery: A monocentric and retrospective study.

Surgical trauma can induce systemic inflammation. The selected anesthesia method may modulate the inflammatory response and surgical results in the inflammatory process that occurs during surgical trauma. In this retrospective study, we aimed to compare the anti-inflammatory effects of general anesthesia and peripheral nerve block (infraclavicular block). Demographic, clinical, and laboratory records (hemogram, total leukocyte count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume) were obtained from the archival data. The patients were divided into 2 groups: Group G, who received general anesthesia, and Group P, who received a peripheral nerve block (infraclavicular block) for forearm surgery. The amount of opioid consumed postoperatively was significantly lower in Group P. Infraclavicular block as an alternative to general anesthesia was found to be associated with a significant decrease in the neutrophil-to-lymphocyte ratio, total leukocyte count, and platelet-to-lymphocyte ratio levels compared to those observed after general anesthesia. Peripheral nerve blocks may play a role in reducing inflammation and alleviating stress.

Infraclavicular versus supraclavicular nerve block for upper limb surgeries: A meta-analysis.

The impact of infraclavicular versus supraclavicular nerve block on the analgesia for upper limb surgeries is unclear. This meta-analysis and systematic review aims to study the analgesic efficacy of infraclavicular versus supraclavicular nerve block for upper limb surgeries. We searched several databases including PubMed, EMbase, Web of science, EBSCO and Cochrane library databases from inception to December 2023, and randomized controlled trials (RCTs) assessing the effect of infraclavicular versus supraclavicular nerve block for upper limb surgeries were included. We excluded studies reporting other nerve block approaches. The methodological quality of the included studies was evaluated by the modified Jadad scale. Standard mean difference with 95% confidence interval (CI) was used to assess continuous outcomes. This meta-analysis was conducted by the fixed-effect model or random-effect model based on the heterogeneity. Eight RCTs and 725 patients were included in this meta-analysis. Compared with supraclavicular nerve block for upper limb surgeries, infraclavicular nerve block was able to significantly increase duration of motor block (SMD = 0.34; 95% CI = 0.12 to 0.56) and decrease readiness for surgery (SMD = -0.43; 95% CI = -0.77 to -0.10), but showed similar duration of sensory block (SMD = 0.17; 95% CI = -0.05 to 0.39), block performance time (SMD = -0.14; 95% CI = -0.51 to 0.22), onset of sensory blockade (SMD = -0.13; 95% CI = -0.59 to 0.33) and onset of motor blockade (SMD = -0.17; 95% CI = -0.26 to 0.12). No high heterogeneity was seen among the included studies. Infraclavicular nerve block may be superior to control the analgesia for upper limb surgeries than supraclavicular nerve block.

Combination of different local anesthetic adjunct for supraclavicular brachial plexus block after arthroscopic shoulder surgery: a prospective randomized controlled trial

BackgroundAcute pain is a major concern after arthroscopic shoulder surgery, supraclavicular brachial plexus blockade has shown favorable postoperative analgesic effects. However, its duration of analgesia does not meet clinical needs. We aimed to explore whether the combination of different local anesthetic adjunct can prolong the analgesic duration of supraclavicular brachial plexus block for arthroscopic shoulder surgery.MethodsIn this prospective randomized controlled trial, we allocated 80 patients into four groups: Group DMD (dexamethasone 10 mg + ropivacaine 100 mg + dexmedetomidine 50 µg + magnesium sulfate 250 mg), Group DM (ropivacaine 100 mg + dexmedetomidine 50 µg + magnesium sulfate 250 mg), Group M (ropivacaine 100 mg + magnesium sulfate 250 mg) and Group D (ropivacaine 100 mg + dexmedetomidine 50 µg). The primary outcome was the time to first request for analgesia. Secondary outcome measures included cumulative opioid consumption at 6, 12, 18, 24, and 48 h postoperatively, VAS scores at 6, 12, 18, 24, and 48 h postoperatively and so on.ResultsThe time to first request for analgesia in Group DMD was significantly longer than Group DM (P = 0.011) and Group M (P = 0.003). The cumulative opioid consumption at 18 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.002) and Group M (P = 0.007). The cumulative opioid consumption at 24 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.016). The VAS score at 6 h postoperatively in Group DMD was significantly lower than in Group DM and Group M. The VAS score at 12 h postoperatively in Group DMD was significantly lower than in Group M. For American Shoulder and Elbow Surgeons Score, Group DMD had a better score than Group DM and Group D.ConclusionsThe analgesic efficacy of supraclavicular brachial plexus blockade combined with dexamethasone, magnesium sulfate, and dexmedetomidine is significantly superior to the combination of magnesium sulfate and dexmedetomidine, and significantly superior to the use of magnesium sulfate alone.Trial registrationThis trial was registered in Chinese Clinical Trial Registry. (ChiCTR2200061181, Date of registration: June 15, 2022, http://www.chictr.org.cn)

Randomized comparison between ultrasound-guided proximal and distal approaches of intercostobrachial nerve block as an adjunct to supraclavicular brachial plexus block for upper arm arteriovenous access procedures

BackgroundsUltrasound-guided proximal and distal approaches of the intercostobrachial nerve (ICBN) blocks facilitate analgesia for upper arm and axillary surgery, though success rates vary and lack clinical comparison. This study compared...

A Comparative Study between Ultrasound-guided Concomitant Infraclavicular Plus Distal Median, Radial, and Ulnar Nerve Blockade Versus Infraclavicular Block Alone

Abstract Background: Peripheral nerve blocks can be used alone as the sole “surgical” anesthetic technique as the initial step in providing prolonged postoperative analgesia. There are studies, where accurate deposition of local anesthetic perineurally has the potential to improve the success rate and reduce the incidence of complications of the infraclavicular block. We hypothesized whether a combined block of the infraclavicular brachial plexus and distal median, radial, and ulnar nerves would accelerate upper extremity anesthesia compared with an infraclavicular block alone. Materials and Methods: This study was a prospective randomized control study conducted among 60 patients undergoing elective and emergency wrist and hand surgeries. A group of 30 patients received an infraclavicular block with 30 mL of a local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine from Group A. Group B received an infraclavicular block with 15 mL of local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine along with distal median, radial, and ulnar nerve blockade with 5 mL each of local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine. Pain score, assessment of sensory and motor functions, block performance time, and surgical anesthesia were observed. Results: The mean block performance time of Group A was 10.9 ± 1.1 min and Group B was 14.7 ± 0.5 min. The difference between the two groups’ block performance minutes was statistically significant (P < 0.001). The difference in the onset of the sensory block between the two groups was statistically significant (P < 0.001). The mean onset of motor blockade between the two groups was statistically very highly significant (P < 0.001). The mean of Group A was 5.0 ± 0.2 and Group B was 2.1 ± 0.4. Conclusion: From this study, we conclude that using an approximately equivalent dose of local anesthetics, combining ultrasound-guided infraclavicular block with distal median, radial, and ulnar nerve blockade shortens the onset time of sensory and motor block with improved block consistency compared to infraclavicular block alone.

Comparison of the analgesic effects of infraspinatus-teres minor interfascial block and interscalene block under ultrasound guidance in patients undergoing arthroscopic shoulder surgery

Objective: To compare the postoperative analgesic efficacy of ultrasound-guided infraspinatus-teres minor interfascial block and interscalene block in shoulder arthroscopic surgery. Methods: A total of 74 patients undergoing shoulder arthroscopic surgery at the Affiliated Hospital of Jiaxing University from December 2023 to February 2024 were prospectively included, whose age ranged from 18 to 80 years and the American Society of Anesthesiologists (ASA) grade were Ⅰ-Ⅲ. Patients were divided into two groups using block randomization: infraspinatus-teres minor interfascial block group (observation group) and interscalene block group (control group), with 37 cases in each group. In the anesthesia preparation room, all patients received nerve blocks under ultrasound guidance with 20 ml of 0.375% ropivacaine. Patient-controlled intravenous analgesia (PCIA) was administered to all patients following surgery. The primary outcome was the area under the curve (AUC) of the numeric rating scale (NRS) for pain within 24 hours postoperatively. Secondary outcome measures included the highest NRS score within 48 hours postoperatively, the amount of sufentanil used via PCIA within 48 hours postoperatively, the incidence of rescue analgesia and rebound pain, QoR-40 scores, and the rate of postoperative nausea and vomiting within 24 hours. The non-inferiority margin for the AUC of NRS scores between the two types of regional nerve blocks was set at "2.6". Results: A total of 35 patients were included in the observation group [17 males, 18 females, aged (58.1±9.1) years], and 36 patients were included in the control group [12 males, 24 females, aged (57.0±9.8) years]. The AUC of the NRS scores at rest within 24 hours post-operation was 51.7±10.9 in the observation group and 62.6±13.6 in the control group. The difference in AUC between the two groups was -10.9 (95%CI:-16.8--5.1), with the upper limit of the 95%CI falling below the predefined non-inferiority margin of "2.6" (non-inferiority P<0.001). The highest NRS score [M (Q1, Q3)] within 48 hours post-surgery was 3 (3, 4) in the control group, which was significantly higher than the observation group's score of 2 (2, 3) (P<0.001). During the postoperative period of 0-12 hours, the observation group received a median dose of 12 (10, 14) μg of sufentanil, which was significantly higher than the control group's dose of 8 (6, 10) μg (P<0.001). During the postoperative period of 12-24 hours, the observation group received a median dose of 8 (8, 10) μg of sufentanil, which was significantly lower than the control group's median dose of 12 (10, 14) μg (P<0.001). During the postoperative period of 24-48 hours, there was no statistically significant difference in the dose of sufentanil between the two groups of patients (P=0.548). In the observation group, the incidence of rescue analgesia within 48 hours postoperatively was 0 (0/35), which was lower than that of the control group at 22.2% (8/36) (P=0.010). The occurrence of rebound pain in the observation group was 0 (0/35), and the control group was 11.1% (4/36), no statistically significant difference was found between two groups (P=0.130). In the observation group, the QoR-40 score within 24 hours post-operation was 180.2±3.2, which was higher than the control group's score of 175.8±4.7 (P<0.001). There was no statistically significant difference in the incidence of postoperative nausea and vomiting within 24 hours between the two groups (P=0.372). Conclusion: Ultrasound-guided infraspinatus-teres minor interfascial block demonstrates a comparable analgesic effect to interscalene block in shoulder arthroscopic surgery within the first 24 hours postoperatively.

Effect of dexmedetomidine combined with ropivacaine block on flap blood flow and patient satisfaction after flap transfer for hand trauma: a randomized controlled trial.

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Evaluation of lateral sagittal infraclavicular block according to inferior vena cava collapsibility index (VCI-CI): An observational study.

Depending on the total amount of fluid, changes occur in the amount of fluid in the peripheral area. The aim of this study was to observe the differences caused by hemodynamic changes after lateral sagittal infraclavicular block (LS-ICB) according to the inferior vena cava collapsibility index (VCI-CI). In this prospective, observational study (Clinical Trial Number: NCT05968105), patients undergoing elective hand and wrist surgery with LS-ICB were classified according to VCI-CI, with Group 1 defined as inferior vena cava (VCI) diameter < 1.5 cm and VCI-CI > 50% and Group 2 defined as VCI diameter > 1.5 cm and VCI-CI < 50%. Groups were compared for demographic characteristics, defined durations, rescue analgesics, and complications. Continuous hemodynamic parameters and pulsed wave Doppler were evaluated within groups. Demographic characteristics and time periods were comparable between the groups. Hemodynamic parameters and pulsed wave Doppler measurements showed no significant differences. However, while Group 1 remained consistent, Group 2 exhibited differences in axillary artery diastolic diameter and axillary artery contractility index. A significant statistical difference was observed in Group 1 for the perfusion index at 30 minutes and postoperatively, whereas Group 2 remained consistent. The dosage and number of patients requiring rescue analgesics were similar across both groups, and no complications were reported. Blood flow increased after LS-ICB without a corresponding increase in axillary artery diameter. Group 1 showed a tendency toward a lower perfusion index in the postoperative period.

A comparative study between dexmedetomidine and dexamethasone as adjuvants to bupivacaine in ultrasound guided interscalene block for arthroscopic shoulder surgery

Background &amp; Objectives: Arthroscopic surgery is a preferred approach for shoulder surgeries due to its documented advantages of early postoperative recovery. However, postoperative pain remains a concern for which different techniques are used. Interscalene block (ISB), using dexmedetomidine (DXM) or dexamethasone (DXA) as adjuvants to local anesthetics (LA), is a common analgesic method. We conducted this comparative study to establish if any one of the adjuvants is better in terms of postoperative analgesia. Methodology: Patients undergoing shoulder arthroscopy were assigned randomly to three groups: Group A (LA alone), Group B (ISB with DXM), and Group C (ISB with DXA). Assessment of intraoperative and postoperative hemodynamics, visual analog scale (VAS) pain scores, time to first rescue analgesic, and rescue analgesic (ketorolac) consumption were recorded. Results: Intraoperative and postoperative heart rate and mean arterial pressure showed no significant differences among the three groups, suggesting comparable hemodynamic control. VAS pain scores were equivalent at 1, 2 and 6 h postoperatively, but at 12, 18 and 24 h, Groups B and C demonstrated significantly lower scores compared to Group A (P &lt; 0.001). Time to first rescue analgesic was prolonged in Groups B and C, indicating improved and longer-lasting analgesia. Groups B and C consumed considerably less ketorolac overall than Group A (P &lt; 0.001). Conclusion: While all three groups exhibited equivalent intraoperative and postoperative hemodynamic control, the addition of dexmedetomidine or dexamethasone to local anesthetics for interscalene block prolonged postoperative analgesia, reduced pain scores at 12, 18 and 24 h, delayed time to first rescue, and decreased total analgesic consumption. Both adjuvants showed advantages over local anesthetics alone, emphasizing their potential in multimodal analgesia for shoulder arthroscopy. Abbreviations: ISB - Interscalene block; DXM - Dexmedetomidine; DXA - Dexamethasone; HR – Heart Rate; MAP – Mean Arterial Pressure; VAS Visual Analog Scale. Trial registry: PACTR202210507488378 Keywords: Analgesia; Analgesia, postoperative; Dexmedetomidine; Dexamethasone; Interscalene block; Pain, postoperative; Shoulder arthroscopy Citation: Nashaat P, Mohamed O, George S, Mohammed A, Samy E. A comparative study between dexmedetomidine and dexamethasone as adjuvants to bupivacaine in ultrasound guided interscalene block for arthroscopic shoulder surgery. Anaesth. pain intensive care 2024;28(5):850−858; DOI: 10.35975/apic.v28i5.2566 Received: June 13, 2024; Reviewed: June 20, 2024; Accepted: July 18, 2024