Nerve Block In Patients Research Articles

Effect of ibuprofen on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: A meta-analysis.

The aim of this study was to compare preventive ibuprofen administration to placebo on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis. A search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, SIGLE, and grey literature. The risk of bias was evaluated through the Cochrane Collaboration's tool. The quality of evidence was assessed using the GRADE approach. Only seven studies remained for the meta-analysis. Administering ibuprofen before anaesthesia increased the success rate of injectable anaesthesia (RR = 1.79; 95% confidence interval (CI) 1.32-2.42; P = 0.0002) even in cases of symptomatic irreversible pulpitis (RR = 1.55; 95% CI 1.05-2.29; P = 0.03). The intensity of pain was lower for ibuprofen (standardised difference means (SMD) = -3.73; 95% CI -6.43 to -1.04; P = 0.007). Ibuprofen as premedication is beneficial for the success of inferior alveolar nerve block.

A comparative study of bilateral ilioinguinal and iliohypogastric nerve block for postoperative analgesia in lower segment cesarean section

Background: Modern techniques incorporate regional anesthesia in pain management and it is the best and safest technique. It avoids the side effects that remain with the traditional use of opioids. Ilioinguinal and iliohypogastric nerve block can provide a satisfactory postoperative analgesia in parturients with pfannenstiel incision thereby reducing postoperative opioid consumption.Objective: To compare opioid consumption and pain relief postoperatively with ilioinguinal and iliohypogastric nerve block in patients undergoing lower segment cesarean section.Methods: It is a hospital based comparative study done in Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke in a period of one year. Total of sixty patients, thirty in each were randomly allocated into the two groups. Group B received bilateral ilioinguinal and iliohypogastric nerve block by landmark technique with 20ml of 0.5% bupivacaine; 10ml in each side. Group NS received ilioinguinal and iliohypogastric nerve block with 20ml of 0.9% normal saline. In postoperative period blood pressure, pulse, oxygen saturation, numerical rating scale score at different allocated duration, total dose of tramadol consumption and time to first dose of tramadol were recorded.Results: The total postoperative tramadol consumption in the first 24hr postoperatively was significantly less in group B (125 ± 34.11mg) than in group NS (205 ±37.93mg). The mean effective duration of analgesia measured from the time of onset of spinal blockade to the time of request for tramadol was 264 ±78.27 minutes in group B and 178.17±30.61minutes in group NS, which was statistically significant and also numerical rating scale scores were low at all points postoperatively in group B.Conclusion: Bilateral ilioinguinal and iliohypogastric nerve block significantly lowers the consumption of tramadol and also provides adequate postoperative pain relief.Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, page: 81-86

Role of local anaesthetic nerve block in patients undergoing endonasal surgery – our experience of 48 patients

Role of local anaesthetic nerve block in patients undergoing endonasal surgery – our experience of 48 patients

Effect of oral premedication on the anaesthetic efficacy of inferior alveolar nerve block in patients with irreversible pulpitis - A systematic review and network meta-analysis of randomized controlled trials.

This systematic review (SR; PROSPERO database: CRD42017075160) and network meta-analysis (NMA) identified the most effective oral premedication for anaesthetic success of inferior alveolar nerve blocks (IANB) in cases of irreversible pulpitis. Medline and Ebscohost databases were searched up until 10/2017. Randomized controlled trials (RCT) studying the effect of oral premedication, alone or in combination, on the success of IANB for cases of irreversible pulpitis, compared to placebo or other oral premedications, were included. Quality of the included studies was appraised by the revised Cochrane risk of bias tool for randomized trials. Pairwise analysis, NMA and quality of evidence assessment using GRADE criteria were performed. Nineteen studies (n=1654 participants) were included. NMA demonstrated that compared to placebo, dexamethasone was most effective in increasing anaesthetic success (RR, 2.92 [95% CI 1.74,4.91]; SUCRA=0.96), followed by NSAIDs (RR, 1.92 [95% CI 1.63,2.27], SUCRA=0.738) and Tramadol (RR, 2.03 [95% CI 1.18,3.49], SUCRA=0.737). Premedication with acetaminophen added to NSAIDs demonstrated similar efficacy as NSAIDs alone (RR, 1.06 [95% CI 0.79,1.43]). Sensitivity analyses proved the superiority of dexamethasone or NSAIDs over any other premedications. Subgroup analyses of specific dosages in comparison with placebo demonstrated that dexamethasone 0.5mg was most effective, followed by ketorolac 10mg, piroxicam 20mg, ibuprofen 400mg+ acetaminophen 500mg and Tramadol 50mg. Ibuprofen 400mg, 600mg and 800mg had a significantly improved IANB success, while Ibuprofen 300mg had no effect. Oral premedication with dexamethasone, NSAIDs or Tramadol significantly increased anaesthetic success. More trials are needed to evaluate the premedication effects of dexamethasone or Tramadol for improved anaesthetic success of IANB when treating irreversible pulpitis.

A comparative analysis of femoral nerve block with adductor canal block following total knee arthroplasty: A systematic literature review.

Background:Patients undergoing total knee arthroplasty suffer from moderate-to-severe postoperative pain resulting in immobility-related complications and prolonged hospitalization. Femoral nerve block is associated with reduction in the quadriceps strength and increasing incidence of falls. Adductor canal block has been shown to be as effective as femoral nerve block without causing quadriceps weakness.Objectives:To compare outcomes of studies comparing adductor canal block and femoral nerve block in patients undergoing primary total knee arthroplasty.Data Sources:Original articles, published between July 2013 and April 2017, comparing the above interventions.Study Eligibility Criteria, Participants, and Interventions:Comparison of outcome measures of all original articles shortlisted by the PUBMED and Google Scholar databases search using key words, “adductor canal block; femoral nerve block; total knee arthroplasty; total knee replacement.”Study Appraisal and Synthesis Methods:The primary outcome measures reviewed were: pain scores; interventional failure; post-operative opioid consumption; patient fall or near fall during postoperative rehabilitation; and length of stay.Results:The opioid consumption was found to be comparable with both the interventions on the first and second postoperative day. Patients administered adductor canal block had better quadriceps power, longer ambulation distance, and shorter length of hospital stay.Limitations:Of the studies reviewed five were retrospective and thus data quality amongst the studies may have been compromised.Conclusions and Implications of Key Findings:Mobilization and ambulation, which are both important for recovery after total knee arthroplasty are both inhibited less by adductor canal block.

Local anesthetic administered with a pressure syringe system probably results in less successful and insufficient anesthesia than an inferior alveolar nerve block in patients undergoing mandibular posterior tooth extractions

Local anesthetic administered with a pressure syringe system probably results in less successful and insufficient anesthesia than an inferior alveolar nerve block in patients undergoing mandibular posterior tooth extractions

Effect of a Combination of Intranasal Ketorolac and Nitrous Oxide on the Success of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Randomized, Double-blind Study

IntroductionPrevious studies in patients with irreversible pulpitis have reported increased success of the inferior alveolar nerve block (IANB) using premedication with ketorolac. Preemptive nitrous oxide administration has also shown an increase in the success of the IANB. Recently, ketorolac has been made available for intranasal delivery. Perhaps combining ketorolac and nitrous oxide would increase success. Therefore, the purpose of this prospective, randomized, double-blind study was to determine the effect of a combination of intranasal ketorolac and nitrous oxide/oxygen on the anesthetic success of the IANB in patients presenting with symptomatic irreversible pulpitis. MethodsOne hundred two patients experiencing spontaneous moderate to severe pain with symptomatic irreversible pulpitis in a mandibular posterior tooth participated. Patients were randomly divided into 2 groups and received either 31.5 mg intranasal ketorolac or intranasal saline placebo 20 minutes before the administration of nitrous oxide/oxygen. Ten minutes after the administration of nitrous oxide/oxygen, the IANB was given. After profound lip numbness, endodontic treatment was performed. Success was defined as the ability to perform endodontic access and instrumentation with no pain or mild pain. ResultsThe odds of success for the IANB was 1.631 in the intranasal saline/nitrous oxide group versus the intranasal ketorolac/nitrous oxide group with no significant difference between the groups (P = .2523). ConclusionsPremedication with intranasal ketorolac did not significantly increase the odds of success for the IANB over the use of nitrous oxide/oxygen alone. Supplemental anesthesia will still be needed to achieve adequate anesthesia.

The Effect of Intra-articular Cocktail Versus Femoral Nerve Block for Patients Undergoing Hip Arthroscopy

To compare clinical efficacy and complication rate as measured by postoperative falls and development of peripheral neuritis between intra-articular blockade and femoral nerve block in patients undergoing arthroscopic hip surgery. An institutional review board approved retrospective review was conducted on a consecutive series of patients who underwent elective arthroscopic hip surgery by a single surgeon, between November 2013 and April 2015. Subjects were stratified into 2 groups: patients who received a preoperative femoral nerve block for perioperative pain control, and patients who received an intra-articular "cocktail" injection postoperatively. Demographic data, perioperative pain scores, narcotic consumption, incidence of falls, and iatrogenic peripheral neuritis were collected for analysis. Postoperative data were then collected at routine clinical visits. A total of 193 patients were included in this study (65 males, 125 females). Of them, 105 patients received preoperative femoral nerve blocks and 88 patients received an intraoperative intra-articular "cocktail." There were no significant differences in patient demographics, history of chronic pain (P= .35), worker's compensation (P= .24), preoperative pain scores (P= .69), or intraoperative doses of narcotics (P= .40). Patients who received preoperative femoral nerve blocks reported decreased pain during their time in PACU (P= .0001) and on hospital discharge (P= .28); however, there were no statistically significant differences in patient-reported pain scores at postoperative weeks 1 (P= .34), 3 (P= .64), and 6 (P= .70). Administration of an intra-articular block was associated with a significant reduction in the rate of postoperative falls (P= .009) and iatrogenic peripheral neuritis (P= .0001). Preoperative femoral nerve blocks are associated with decreased immediate postoperative pain, whereas intraoperative intra-articular anesthetic injections provide effective postoperative pain control in patients undergoing arthroscopic hip surgery and result in a significant reduction in the rate of postoperative falls and iatrogenic peripheral neuritis. Level III, retrospective comparative study.

A comparative clinical study to evaluate the effectof premedication with Ibuprofen, Tramadol and combination of Ibuprofen and Acetaminophen on success of Inferior Alveolar Nerve Block in patients with Asymptomatic Irreversible Pulpitis.

Introduction: Aim of this study was to evaluate the effective of premedication and to determine the difference between non steroidal anti- inflammatory drugs and centrally acting opioids like tramadol on success rate of inferior alveolar nerve block in patients with asymptomatic irreversible pulpitis.Methods: This double blind clinical study was conducted on 60 patients with asymptomatic irreversible pulpitis in first or second mandibular molar with normal periapical radiographic findings. Three medications i.e., ibuprofen (600mg), tramadol (50 mg) and combination of ibuprofen (400 mg) + acetaminophen (325) were compared and lactose powder capsules were taken as placebo. All patients received IANB and teeth were examined with a cold pulp test using endofrost. Then, endodontic access cavity preparation was initiated. In case of pain during treatment, patients were asked to rate their pain on the visual analog scale.Results: The tramadol group showed significantly higher success rates but ibuprofen and combination of ibuprofen and acetaminophen groups were not significant with placebo (p>05). No Significant differences were there regarding sex of the patients.Conclusion: Premedication with tramadol increased the success rate of IANB.Bangladesh Journal of Medical Science Vol.16(3) 2017 p.370-374

Ultrasound-guided para-umbilical block: a pediatric case

BackgroundRectus sheath block is a common peripheral nerve block for patients undergoing umbilical hernia repair surgery. However, rectus sheath block alone can affect only anterior branches of intercostal nerves and, therefore, is incomplete for postoperative analgesia for the anterior abdomen, which is innervated by both anterior and lateral branches. We describe a successful perioperative analgesia with ultrasound-guided para-umbilical block after pediatric umbilical hernia surgery.Case presentationA 4-year-old child underwent hernia repair surgery. Following induction of general anesthesia, the anatomy of the umbilical region was observed under ultrasound with a 5–10-MHz linear probe. An ultrasound-guided injection between the rectus abdominis muscle and the posterior lobe of the rectus sheath and an injection into the subcutaneous space around the umbilicus were performed. The peripheral nerve block was effective during surgery, and the patient required no additional rescue analgesia during the perioperative period. There were no complications.ConclusionWe performed ultrasound-guided para-umbilical block with four injections. This peripheral nerve block could be an efficient technique for complete perioperative analgesia.

Combined Sciatic and Lumbar Plexus Nerve Blocks for the Analgesic Management of Hip Arthroscopy Procedures: A Retrospective Review

ABSTRACTHip arthroscopy is a minimally invasive alternative to open hip surgery. Despite its minimally invasive nature, there can still be significant reported pain following these procedures. The impact of combined sciatic and lumbar plexus nerve blocks on postoperative pain scores and opioid consumption in patients undergoing hip arthroscopy was investigated. A retrospective analysis of 176 patients revealed that compared with patients with no preoperative peripheral nerve block, significant reductions in pain scores to 24 hours were reported and decreased opioid consumption during the post anesthesia care unit (PACU) stay was recorded; no significant differences in opioid consumption out to 24 hours were discovered. A subgroup analysis comparing two approaches to the sciatic nerve block in patients receiving the additional lumbar plexus nerve block failed to reveal a significant difference for this patient population. We conclude that peripheral nerve blockade can be a useful analgesic modality for patients undergoing hip arthroscopy.

The Analgesic Efficacy of Sciatic Nerve Block in Addition to Femoral Nerve Block in Patients Undergoing Total Knee Arthroplasty

(Abstracted from Anaesthesia, 2016; 71(10):1198–1209) Placement of a sciatic nerve block can be challenging and carries some risk to a patient. Therefore, the inclusion of a sciatic nerve block for total knee arthroplasty requires further evidence supporting its efficacy.

Adding Corticosteroids to the Pudendal Nerve block for Pudendal Neuralgia: A Randomised, Double-blind, Controlled Trial

(Abstracted from BJOG 2016; DOI: 10.1111/1471-0528.14222) Management of pudendal neuralgia (PN) is often not evidence based. The practice of adding corticosteroids to a nerve block in patients with PN is widespread and largely based on a few studies suggesting that corticosteroids may prolong the effect of a local anesthetic.

The effects of perineural dexmedetomidine on the pharmacodynamic profile of femoral nerve block: a dose-finding randomised, controlled, double-blind study.

This randomised, controlled, double-blind study investigated the effects of different doses of perineural dexmedetomidine on the pharmacodynamic profile of femoral nerve block in patients undergoing arthroscopic knee surgery. Ultrasound-guided femoral nerve block was performed before general anaesthesia using 25ml of bupivacaine 0.5% combined with normal saline in the control group, and 25μg, 50μg or 75μg of dexmedetomidine in three treatment groups (n=15 for each group). All patients received a standard general anaesthetic and multimodal postoperative analgesic regimen. The use of the 50μg and 75μg dose levels of dexmedetomidine was associated with reduction of the onset time, extension of the duration of block, prolonged time to the first postoperative request for rescue analgesia, and reduced postoperative morphine requirements. The times to first request for postoperative analgesia were mean (SD) 10.8 (1.6)h in the control group and 11.0 (7.1), 21.8 (3.0) and 28.6 (10.0) in the 25μg, 50μg and 75μg treatment groups, respectively. These times were significantly longer in the 50μg and 75μg treatment groups compared with the 25μg (p<0.0001) and control group (p<0.0001). The total 24-h postoperative morphine consumption was 7.6 (5.1)mg in the control group, and 6.5 (3.5), 3.9 (3.4), 1.8 (2.6) in the 25μg, 50μg and 75μg treatment groups, respectively. Postoperative morphine consumption was significantly higher in the control group compared with the 50μg (p=0.045) and the 75μg (p=0.001) treatment groups. The best analgesic profile was achieved at the 75μg dose, but this was associated with increased risk of hypotension.

Anesthetic management using peripheral nerve block in patients with factor XI deficiency: a case report

Factor XI deficiency is rare but may cause life-threatening bleeding during the perioperative period. The clinical manifestation of factor XI deficiency is characterized by bleeding tendency. This unpredictable bleeding tendency makes anesthetic management difficult. We report a case of a partial duodenectomy in a patient with factor XI deficiency. The patient was scheduled for duodenectomy because of a duodenal tumor. When checked for coagulation before surgery, the patient was found to have a remarkably prolonged activated partial thrombin time, and further investigation revealed factor XI deficiency. Fresh frozen plasma was transfused before surgery, and general anesthesia and peripheral nerve block were performed. In the present case of factor XI deficiency, supplementation with clotting factor and proper anesthetic management were important to prevent severe complications.

The analgesic efficacy of sciatic nerve block in addition to femoral nerve block in patients undergoing total knee arthroplasty: a systematic review and meta‐analysis

The aim of this meta-analysis was to assess the postoperative analgesic efficacy of sciatic nerve block when combined with femoral nerve block after total knee arthroplasty. Outcomes included resting pain scores (analogue scale, 0-100), intravenous morphine consumption at 12 h, 24 h and 48 h postoperatively, and functional outcomes comprising knee flexion, distance walked, and length of stay. Twelve randomised controlled trials were included, with a total of 600 patients. When combined with femoral nerve block, sciatic nerve block significantly reduced resting pain scores at 12 h postoperatively with a mean difference of 10 (95% CI: -15 to -5; p < 0.00001). Resting pain scores at 24 h, and intravenous morphine consumption at 12 h, 24 h and 48 h postoperatively were also significantly reduced, but without clinical significance beyond 12 h and without affecting functional outcomes. In conclusion, sciatic nerve block confers additional postoperative analgesia within the first 12 postoperative hours compared with femoral nerve block alone for patients undergoing total knee arthroplasty.

Effects of age factors on pharmacokinetics of ropivacaine during combined lumbar plexus-sciatic nerve block

Objective To evaluate the effects of age factors on the pharmacokinetics of ropivacaine during combined lumbar plexus-sciatic nerve block in patients. Methods Twenty patients of both sexes, aged ≥18 yr, weighing 50-75 kg, of American Society of Anesthesiology physical status Ⅰ or Ⅱ, scheduled for elective lower extremity surgery, were divided into 2 groups (n=10 each) according to age: young and middle-aged group (18-59 yr) and elderly group (≥ 60 yr). Combined lumbar plexus-sciatic never block was performed using an ultrasonic instrument and a nerve stimulator.Lumbar plexus block was performed with 0.5% ropivacaine 30 ml.Sciatic never block was performed with 2% lidocaine 10 ml plus 0.75% ropivacaine 10 ml.Before administration and at 5, 10, 15, 20, 30, 45, 60, 120, 180 and 360 min after administration, blood samples were collected from the radial artery for determination of the blood concentration of ropivacaine by high-performance liquid chromatography.The area under the concentration-time curve, maximum concentration (Cmax), time to Cmax, terminal elimination half-life and clearance were calculated. Results Compared with young and middle-aged group, the blood concentration of ropivacaine was significantly decreased at 5-45 min after administration, the Cmax was significantly decreased, terminal elimination half-life was significantly prolonged (P 0.05). Conclusion Age factors can affect the pharmacokinetics of ropivacaine during combined lumbar plexus-sciatic nerve block, and both absorption and metabolism of ropivacaine are slower in elderly patients than in young and middle-aged patients. Key words: Age factor; Amides; Pharmacokinetics; Lumbosacral plexus; Sciatic nerve; Neuromuscular blockade

Anaesthetic efficacy of lidocaine/clonidine for inferior alveolar nerve block in patients with irreversible pulpitis

This prospective, randomized, double-blind study aimed to compare the efficacy of lidocaine with epinephrine versus lidocaine with clonidine for inferior alveolar nerve block (IANB) and hemodynamic stability (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) in patients with irreversible pulpitis. One hundred patients with irreversible pulpitis in mandibular molar teeth randomly received 1.8 mL of 2% lidocaine with clonidine (15μgmL-1 ) or 1.8 mL of 2% lidocaine with epinephrine (12.5μgmL-1 ), using a conventional IANB technique. Endodontic access cavities were prepared 15min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as no or mild pain (visual analog scale recording) upon endodontic access cavity preparation or initial canal instrumentation. The hemodynamic parameters were measured before, during and 5, 10 and 30min after administration. Finally, the collected data were subjected to independent t-test, chi-square and Fisher's exact test using spss software ver.20 at a significant level of 0.05. The success rates for IANB using lidocaine with epinephrine and lidocaine with clonidine solutions were 29% and 59%, respectively. The clonidine group exhibited a significantly higher success rate (P<0.05). Five minutes after drug administration, systolic blood pressure and heart rate significantly increased in the lidocaine with epinephrine group and insignificantly decreased in lidocaine with clonidine group. For mandibular molars with irreversible pulpitis, addition of clonidine to lidocaine improved the success rate of IANB compared to a standard lidocaine/epinephrine solution.

Peripheral nerve block in patients with Ehlers-Danlos syndrome, hypermobility type: a case series

Study ObjectiveEhlers-Danlos syndrome (EDS) is an inherited disease characterized by defects in various collagens or their post translational modification, with an incidence estimated at 1 in 5000. Performance of peripheral nerve block in patients with EDS is controversial, due to easy bruising and hematoma formation after injections as well as reports of reduced block efficacy. The objective of this study was to review the charts of EDS patients who had received peripheral nerve block for any evidence of complications or reduced efficacy. DesignCase series, chart review. SettingAcademic medical center. PatientsPatients with a confirmed or probable diagnosis of EDS who had received a peripheral nerve block in the last 3 years were identified by searching our institutions electronic medical record system. InterventionsThe patients were classified by their subtype of EDS. Patients with no diagnosed subtype were given a probable subtype based on a chart review of the patient's symptoms. MeasurementsPatient charts were reviewed for any evidence of complications or reduced block efficacy. Main ResultsA total of 21 regional anesthetics, on 16 unique patients were identified, 10 of which had a EDS subtype diagnosis. The majority of these patients had a diagnosis of hypermobility-type EDS. No block complications were noted in any patients. Two block failures requiring repeat block were noted, and four patients reported uncontrolled pain on postoperative day one despite successful placement of a peripheral nerve catheter. Additionally, blocks were performed without incident in patients with classical-type and vascular-type EDS although the number was so small that no conclusions can be drawn about relative safety of regional anesthesia in these groups. ConclusionsThis series fails to show an increased risk of complications of peripheral nerve blockade in patients with hypermobility-type EDS.

Efficacy of Ketorolac Buccal Infiltrations and Inferior Alveolar Nerve Blocks in Patients with Irreversible Pulpitis: A Prospective, Double-blind, Randomized Clinical Trial

IntroductionThe purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine whether ketorolac buccal infiltrations (BIs) helped to improve the success of inferior alveolar nerve blocks (IANBs) in patients with acute irreversible pulpitis (AIP). MethodsForty adult volunteers with AIP in a mandibular molar were included in this study. Patients were instructed to evaluate their pain by using a Heft-Parker visual analog scale. They were randomly divided into 2 groups (n = 20). All patients received standard IANB injection and after that a BI of 4% articaine with 1:100,000 epinephrine. After 5 minutes, 20 patients received a BI of 30 mg/mL ketorolac, and the other received a BI of normal saline (control group). Endodontic access cavity preparation (ACP) was initiated 15 minutes after the IANB when the patient reported lip numbness and had 2 electric pulp tests with no responses. The patient's pain during caries and dentin removal, ACP, and canal length measurements (CLM) was recorded by using Heft-Parker visual analog scale. Successful anesthesia was defined as no or mild pain during any of these steps, without the need for additional injection. Data were statistically analyzed by using Mann-Whitney U and χ2 tests. ResultsSuccessful anesthesia after an IANB plus BI of articaine was obtained in 15% of patients in the control group at the end of CLM. Adding BI of ketorolac significantly increased the success rate to 40% (P < .05). Patient's pain during ACP and CLM was significantly lower in the ketorolac group (P < .05). ConclusionsKetorolac BI can increase the success rate of anesthesia after IANB and BI with articaine in patients with AIP.