Performance Of Nerve Blocks Research Articles

Emergency practitioner-administered ultrasound nerve blocks in the emergency department: A retrospective analysis

Abstract OBJECTIVES: In the realm of acute pain management within emergency departments (EDs), the prevalent reliance on systemic analgesics, notably opioids, presents challenges due to associated risks and suboptimal efficacy. The emerging alternative of ultrasound-guided nerve blocks (USGNBs) has shown promise in prospective studies. However, the safety and efficacy of USGNBs when performed by emergency medicine practitioners remain largely unexplored, necessitating this study to address the research gap. The primary objectives of this study were to assess the efficacy of Emergency physician-performed USGNBs and changes in patient-reported pain (pre- and postnerve block) at 15 and 30 min. In addition, the time taken to perform nerve blocks, type of nerve block, frequency, indications, procedure time, and complications were all studied. METHODS: Conducted at a Tertiary Care Teaching Hospital in Pune, India, this single-center, retrospective observational study aimed to evaluate the effectiveness of USGNBs in the ED context. A retrospective analysis covered 274 emergency practitioner-performed USGNBs recorded from January 2022 to December 2023. Participants included consecutive ED patients consenting to nerve blocks, with practitioners utilizing bupivacaine (0.25%) and ropivacaine (0.25%) based on individual preferences. The study systematically recorded patient demographics, block types, indications, complications, and pre- and postpain scores on a Numerical Rating Scale. RESULTS: The study demonstrated a significant reduction in pain scores post-USGNB, with an average decrease of 2.9 ± 1.08 at 15 min and 5.8 ± 1.39 at 30 min. Commonly performed blocks included the femoral nerve, fascia iliaca, and serratus anterior, with notable pain relief in fracture management cases. Procedural durations varied, ranging from 2 to 12 min, while four complications were reported, including diaphragmatic paresis and arterial punctures during interscalene nerve block and fascia iliac compartment blocks, respectively. CONCLUSION: This extensive study in an academic ED setting supports the proficiency of emergency practitioners in performing USGNBs. The findings emphasize the transformative potential of USGNBs in academic ED pain management, showcasing notable pain reduction and minimal complications. These results advocate for the integration of advanced pain relief techniques into emergency medicine training programs, contributing to a comprehensive approach to acute pain management.

A Method of Tumescent Anesthesia Based on Facial and Cervical Nerve Block for Face and Neck Liposuction.

Liposuction of the face and neck is a common treatment for fat deposition. If conventional methods are used for tumescent anesthesia, patients will experience pain, affecting their surgery experience. Using general anesthesia for liposuction of the face and neck can increase the cost to the patient and cause various adverse effects. The authors selected appropriate parts of the patient's neck, angle of the mandible, and face as needle entry points, and performed nerve block in different directions. Afterward, we performed facial liposuction on these patients and evaluated their level of pain. This study included a total of 20 female participants who underwent facial liposuction after a nerve block. The Visual Analog Scale score of the 20 participants was 0.55 (±0.60). There were no significant adverse reactions during the treatment process, and all patients expressed satisfaction with this treatment. In this article, the authors present a method of tumescent anesthesia based on facial and cervical nerve block that significantly reduces the pain associated with facial and neck liposuction, eliminating the need for general anesthesia and enhancing the patient's comfort during the procedure.

Objective methods of nerve localisation to facilitate performing locoregional anaesthetic techniques for horses undergoing surgical procedures

SummaryPerineural anaesthesia is a useful technique in equine surgery, providing pre‐emptive targeted anaesthesia of the surgical site, reducing volatile anaesthetic requirements, improving recovery quality and providing postoperative pain relief. Surgery under standing sedation in horses has increased in popularity, mandating the need for effective locoregional anaesthesia and analgesic techniques. Nerve location techniques offer greater accuracy than blind techniques when placing injectate. These methods can help to avoid structures such as blood vessels and minimise direct nerve damage during needle placement, reducing the risk of procedure‐related complications. This review will discuss the most pertinent research in the veterinary literature where objective methods of nerve location have been used to perform peripheral nerve blocks in horses. The efficacy of using objective methods to perform nerve blocks in equine anaesthesia is discussed by the authors, providing useful information to equine anaesthetists, and potentially improve the quality of anaesthesia and analgesia in horses.

A survey about the practice of regional anesthesia in Manchester and Lancashire.

In 2021, the UK Royal College of Anaesthetists published an updated curriculum which outlines specific peripheral nerve blocks in which all anesthetists must achieve competency during their training. Little is known about which nerve blocks anesthetists in the UK can perform, nor which techniques they use to perform them. We conducted a survey of anesthetists in North West England to discover their experience in anesthesia, which nerve blocks they can perform, and which techniques they use to perform them. Overall, 195 responses were received. Seventy-nine respondents (44%) preferred to perform nerve blocks on anesthetized patients, 70 (40%) preferred to perform nerve blocks with the patient awake with no sedation. One hundred and thirty-seven (85%) respondents used ultrasound only to localize nerves when performing a block. Among consultant respondents, 21 (19%) were unable to perform any upper limb block, and 48 (44%) were unable to perform any block of the thorax, both are a required competency of trainees under the 2021 curriculum. Trainees may struggle to achieve the required competencies of the new curriculum given many consultants are also unable to perform them. A structured placement in regional anesthetic training in each stage of training could help improve the acquisition of skills and knowledge among trainees. Further studies are needed to assess the ability of anesthetists nationwide in regional anesthesia.

A New Injection Method of Nerve Block Combined with Local Infiltration Anesthesia for Relieving Pain of Horizontal Neck Lines Injection.

Filler injection is an effective method for the treatment of horizontal neck lines, but injection pain presents a burden for many patients. Topical anesthesia and local refrigeration are common methods to relieve the pain of injection, each of which has disadvantages. The transverse cervical nerve is the main innervating nerve for pain sensation in the anterior skin of the neck. The authors performed nerve block anesthesia and local infiltration anesthesia on one side of horizontal neck lines and applied topical anesthesia cream on the other side of the neck in 100 patients. The pain level with nerve block anesthesia and local infiltration anesthesia was reduced by 81% compared with the pain level with topical anesthesia. This treatment did not affect surgeon judgment on neck line shape and shortened treatment time. This new method can be used to relieve the pain of neck line injection.

Mixed-Model Curriculum for Nerve Block Education in Emergency Medicine Residency.

Introduction With the rising opioid epidemic, there has been a push for multimodal pain management within the emergency department. Nerve blocks have been shown to be an effective pain management strategy for many conditions, with improved success when used with ultrasound. However, there is no generally accepted method for teaching residents how to perform nerve blocks. Materials and methods Seventeen residents from a single academic center were enrolled. The residents were surveyed pre-intervention regarding demographics, confidence, and use of nerve blocks. The residents then completed a mixed-model curriculum that included an electronic module (e-module) on three plane nerve blocks and a practice session. Three months later, residents were tested on their ability to independently perform the nerve blocks and resurveyed regarding confidence and use. Results Of the 56 residents in the program, 17 enrolled in the study; 16 participated in the first session, and nine participated in the second session. Each residenthad < four ultrasound-guided nerve blocks prior to participationwith a slight increase in the total number of nerve blocks after the sessions. Residents were able to perform, on average, 4.8 of seven tasks independently. Residents who completed the study reported feeling more confident in their ability to perform ultrasound-guided nerve blocks (p = 0.01) and to complete associated tasks (p < 0.01). Conclusion This educational model resulted in residents completing the majority of tasks independently with improved confidence in ultrasound-guided nerve blocks. There was only a slight increase in clinically performed blocks.

High-Efficiency Ultrasound-Guided Regional Nerve Block Workshop for Emergency Medicine Residents.

This small-group workshop is designed for emergency medicine residents. This workshop can also be offered to medical students or faculty interested in reviewing and practicing ultrasound-guided regional nerve blocks. Ultrasound-guided regional nerve block (UGRNB) is a method used to administer local anesthesia to otherwise unreachable locations on the body and may be used in the management of various painful conditions seen in the emergency department. The ultrasound curriculum of our residency program is longitudinal. All residents spend time with the ultrasound director throughout their training, engage in daily bedside ultrasound, and have regular skills training on the various clinical applications of ultrasound. Additionally, all residents have a required ultrasound rotation dedicated to performing bedside ultrasound in the Emergency Department. Although others have outlined approaches to teaching emergency medicine residents the techniques needed to perform UGRNBs, the value of taking a one-day, high-efficiency teaching strategy with a narrow focus on practical application has yet to be appreciated. The objective of this workshop is to provide emergency medicine residents the confidence and skill sets needed to effectively perform five commonly used UGRNBs for conditions encountered in the emergency department. Through this one-day, accelerated workshop, residents will be given an opportunity to sharpen their UGRNB technique prior to applying them in the clinical environment. By the end of this workshop, learners will be able to: 1) recognize the clinical situations in which UGRNBs can be utilized and understand the associated risks, 2) list the commonly used local anesthetic medications and their proper dosing in respect to regional nerve blocks, 3) demonstrate proper ultrasound probe positioning and identify relevant anatomical landmarks for each nerve block on both standardized patients and cadavers, 4) describe the common steps involved to perform each nerve block, 5) perform the five UGRNB techniques outlined in this workshop. Small group activity combining didactic learning, case-based learning, and procedural simulation. The didactic component may be delivered in an asynchronous learning or "flipped classroom" format. In-person interviews of the learners were obtained following the debriefing session during which they were asked about their enjoyment and satisfaction with the workshop. In addition, learners were asked about the value of the activities for their clinical practices and to provide formative feedback regarding the design of the workshop. Overall, participants reported high levels of enjoyment, and many verbalized their satisfaction with the expeditious and pragmatic nature of the workshop. Some participants commented that they were looking forward to future workshops of similar design. Participants also stated that they felt more confident performing nerve blocks and looked forward to applying these skills in the clinical setting. A focused small-group workshop directed towards developing the confidence and skill set necessary to perform UGRNBs can be successfully offered to emergency medicine residents in a single-day workshop. Ultrasound, nerve block, local anesthesia, injection, pain, resident, workshop.

ОСОБЕННОСТИ ТОПОГРАФО-АНАТОМИЧЕСКОГО СТРОЕНИЯ КРЫЛОВИДНО-НИЖНЕЧЕЛЮСТНОГО ПРОСТРАНСТВА, ВЛИЯЮЩИЕ НА ЭФФЕКТИВНОСТЬ ПРОВЕДЕНИЯ БЛОКАД НЕРВОВ И ДРУГИХ ХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВ

Introduction. The region of the pterygo-mandibular space is an anatomical formation that is quite often sub- jected to surgical interventions (blockade of the mandibular nerve and its branches, operations for purulent processes, injuries). Among the complications of these surgical interventions, there are contractures of the lower jaw, neuritis of the lower alveolar and lingual nerves, and failure of anesthesia during blockades of these nerves. The purpose of the study was to analyze literature data and anatomical preparations of the pterygo-mandibular space, to take into account different options for the location of nerves and blood vessels during blockades and operations. Material and methods. The analysis of the literature and our own anatomical studies of 8 preparations of the deep parts of the human head was carried out. Results and discussion. The pterygo-mandibular space has a rather complex topographic and anatomical structure. Its anatomical structures are mobile along with the lower jaw and, accordingly, are adapted to these conditions in the form of a tortuous course of nerves and blood vessels, which prevents their stretching, tension, and injury. These features must be taken into account when performing surgical interventions, blockades of sensory and motor nerves in this area. Spatial perception of the location of the anatomical structures of the pterygo-mandibular space is facilitated by describing them relative to the lateral and medial muscles. Conclusions: The topographic and anatomical structure of the pterygo-mandibular space is variable and complex, which must be taken into account when performing nerve blocks, diagnostics, operations for purulent processes and traumatic injuries. The pterygo-mandibular space, connected directly with the peripharyngeal, should also be considered as part of the oral pharynx communicating with the base of the skull and neck.

Spinal Anesthesia Versus Popliteal and Adductor Canal Blocks for Ambulation After Pott's Fracture Surgery

Abstract Background Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuroaxial block is used for postoperative pain management and decrease analgesic use. Objective To compare the effect of spinal anesthesia versus popliteal and adductor canal blocks for ambulation after pott's fracture surgery. Patients and Methods Type of Study: Randomized Clinical Trial. Study Setting: Ain Shams university hospitals. Study Period: 3 months from March to May 2019. Results On the other hand, the side effects of peripheral nerve block surgery limit the usefulness of the procedure. The common side effects are: incomplete block, direct nerve damage, localized hematoma and consequent ischemic damage, infection, and the risk of intravenous administration of local anesthetic. In our study we compared spinal anaesthia with nerve blocks for pott’s fracture and found that the time to perform spinal block was shorter than that needed to perform nerve blocks. Conclusion The adductor-popliteal canal provides longer duration of analgesic, better intraoperative hemodynamics, and decreased need for postoperative rescue analgesia in comparison with spinal anaesethia in patients with pot’s fracture ankle surgery.

416 ANALGESIA AND PERI-OPERATIVE PRACTICE IN FRACTURED NECK OF FEMURS AT YORK TEACHING HOSPITALS NHS FOUNDATION TRUST

Abstract Introduction Fractured neck of femurs are a significant public health issue. Prompt assessment and response to pain as per NICE guidelines aids speedy recovery and helps to prevent complications such as delirium in and already high risk, elderly population. Previous audits have found poor documentation of the assessment of pain and the rate of nerve blocks in A + E and theatres. This completed cycle audit will assess the interventions made in response to these audits including adding pain scores to e-observations and training staff to perform nerve blocks. The aim of this audit was to assess current anaesthetic and analgesic practice. Method This was a retrospective review of 32 case notes and electronic prescribing over November—December 2019. Data collected included documentation of pain assessment, which analgesia was prescribed as per NICE guideline CG124 [1] and rate of nerve block in A + E and theatres. Results The audit found that 100% of patients received analgesia as per NICE guidelines. Documenting the assessment of pain scores has improved from 44% to 63% in A + E, 64% to 81% on the ward pre-operatively and 0 to 100% post op. On admission, 41% of patients received a nerve block and 94% intra-operatively, up from 22% and 55% respectively, the majority of patients received a fascia iliaca block (FIB). Conclusions The large increase in post op pain assessment is likely credited to mandatory input as part of e-observations and overall practice has improved significantly. A refresher training session will be provided for nursing staff to re-iterate the importance of assessing and responding to pain. The Hip Fracture Specialist Nurse is now competent to perform FIBs which may further increase the number performed on admission. Reference 1. NICE. Hip fracture: management. Clinical guideline [CG124]. https://www.nice.org.uk/guidance/cg124 (accessed 15/11/2020).

Applied Anatomy of the Maxillofacial and Mandibular Regions of Indian Mithun (Bos frontalis) and its Clinical Significance in Regional Anesthesia

Background: The topographic and morphometric anatomy of various foramina provides an easy approach in performing nerve blocks by their proper tracking for regional anesthesia in surgical interventions. There is no previously reported information on the applied anatomy and clinical significance of the maxillofacial and mandibular regions of the Indian mithun. The present study was designed to provide important clinical landmarks related to tracking of the infraorbital, mental and mandibular nerves with its clinical significance in regional anesthesia in mithun. Methods: The study was conducted on the maxillofacial and mandibular regions of twelve (n=12) adult Indian mithun of either sex (n=6, male and n=6, female). The head region samples of naturally died mithun were collected from different parts of the Mizoram and Nagaland state of India and processed as per the standard maceration technique. Altogether, a total of twelve measurements were taken in the maxillofacial and mandibular regions of mithun by using a digital vernier caliper and the results were expressed as mean±standard deviation. The obtained parameters from the present study can be useful for an extraoral and intraoral approach for nerve block of the infraorbital, mental and mandibular nerve in the maxillofacial and mandibular regions of mithun. Result: The present study revealed that all the obtained parameters related to regional anesthesia showed a significant statistical difference (P less than 0.01** and P less than 0.05*) between the males and females of mithun. It can be concluded from the present study that the various applied parameters of the present study will aid the clinicians in the implication of regional anesthesia in the head region of mithun.

A review of the anatomy and a step-by-step visual guide to performing an ultrasound-guided infraclavicular brachial plexus block

Background: The aim of this description is to provide step-by-step guidelines for performing an ultrasound guided infraclavicular brachial plexus nerve block. Methods: The brachial plexus in the infraclavicular fossa of sixty healthy volunteers was scanned in the horizontal/transverse plane. The relevant regional anatomy was studied to identify the muscular and vascular structures seen on the ultrasound screen. Results: The entire process was documented and a standard, step-by-step guide to performing ultrasound guided vertical infraclavicular brachial plexus blocks was developed. Conclusion: The development of high-resolution ultrasound guidance has allowed for the direct visualisation of the brachial plexus when performing nerve blocks. Ultrasound-guided infraclavicular brachial plexus nerve blocks are becoming more popular. This description aimed to provide step-by-step guidelines on how to perform this block safely and efficiently.

Comparison of ultrasound-guided lumbar plexus and sciatic nerve blocks with ropivacaine and sham blocks with saline on perianesthetic analgesia and recovery in dogs undergoing tibial plateau leveling osteotomy surgery

ObjectiveTo assess the effects of ultrasound-guided lumbar plexus and sciatic nerve blocks on perianesthetic analgesia and recovery quality in dogs undergoing tibial plateau leveling osteotomy (TPLO). AnimalsA group of twenty 20 dogs. Study designProspective, randomized, blinded, clinical study. MethodsDogs were administered lumbar plexus and sciatic nerve blocks with ropivacaine (1.5 mg kg–1; group RA) or sham blocks with saline (group CON). Dogs were administered hydromorphone (0.2 mg kg–1) and atropine (0.02 mg kg–1) subcutaneously before anesthesia was induced with intravenous propofol and maintained with isoflurane. Variables included duration to perform nerve blocks, intraoperative rescue analgesia, recovery score, postoperative pain scores (modified University of Melbourne, Colorado State University and visual analog pain scales), postoperative rescue analgesia-sedation and complications observed. Two-tailed Student t test, Mann–Whitney test, repeated measures analysis of variance, Friedman test and Fisher exact test were used for comparison. Significance was p < 0.05. ResultsTime to perform nerve blocks was [median (range)] 4.3 (2.6–6.1) minutes after aseptic skin preparation. Total fentanyl requirements were 14.2 ± 9 μg kg–1 and 25.4 ± 10 μg kg–1 (p = 0.02) and incidence of hypotension (mean arterial pressure < 60 mmHg) was 40% and 80% (p = 0.16) for groups RA and CON, respectively. Six of eight group CON dogs required more intensive treatment for hypotension than group RA dogs. Recovery scores were 1 (1–4) and 2.5 (1–4) for groups RA and CON, respectively (p = 0.04). RA dogs were less likely to require fentanyl rescue analgesia during the postoperative period (p = 0.04). Conclusion and clinical relevanceAs part of a multimodal analgesia regimen, ultrasound-guided lumbar plexus and sciatic nerve blocks provided greater analgesia and improved recovery quality in dogs during TPLO surgery.

Are peripheral nerve blocks effective in pain control of pediatric orthopedic tumor surgery?

This study aims to evaluate the efficacy of ultrasound (US)-guided peripheral nerve blocks in postoperative analgesia after pediatric orthopedic tumor surgery. This retrospective study included 108 children (64 boys, 44 girls, mean age 10.23 years; range, 2 to 18 years) who were performed orthopedic tumor surgery under general anesthesia. The children were divided into two groups as those who were performed nerve block for postoperative pain control (group 1, n=54) and those who were performed intravenous analgesic (group 2, n=54). In group 1, nerve blocks were performed with bupivacaine 0.25%. In group 2, intraoperative acetaminophen 15 mg/kg was performed intravenously. Postoperative visual analog scale (VAS) scores, time to pain onset, nausea, vomiting, total analgesic consumption in 24 hours, and complications were recorded at first, second, sixth and 24th hours. Visual analog scale scores were higher in group 2 than group 1 at first, second, and sixth hours, but were not different at 24th hour. Mean time to pain onset was 10.2 hours in group 1 and 1.8 hours in group 2 (p<0.05). Mean time to pain onset and VAS values at first, second, sixth and 24th hours did not differ between nerve block types. Nausea and vomiting rates were not different between groups 1 and 2 (18.51% and 16.66%, respectively; p=0.4). Total analgesic consumption in 24 hours was higher in group 2 compared to group 1 (1.7 and 0.07 mg/kg, respectively; p<0.05). Pain-free periods extending up to 10 hours provided by US-guided peripheral nerve blocks may help recovery while reducing postoperative analgesic use and their side effects.

AIUM Practice Parameter for the Use of Ultrasound to Guide Vascular Access Procedures.

AIUM Practice Parameter for the Use of Ultrasound to Guide Vascular Access Procedures.

Practical guide for the management of systemic toxicity caused by local anesthetics.

Systemic toxicity from local anesthetics can occur in any of the wide range of situations in which these agents are used. This practical guide is created to generate a shared awareness of the prevention, diagnosis, and treatment of local anesthetic systemic toxicity among all medical professionals who perform nerve blocks. Systemic toxicity of local anesthetic is induced by an increase of its protein-unbound plasma concentration. Initial symptoms are characterized by central nervous system signs such as excitation, convulsions, followed by loss of consciousness and respiratory arrest. These symptoms are often accompanied with cardiovascular signs such as hypertension, tachycardia and premature ventricular contractions. Further increase of plasma concentration of local anesthetic induces bradycardia, conduction disturbances, circulatory collapse and asystole. The incidence of local anesthetic systemic toxicity is 1-11 cases per 10,000. Infants, patients with decreased liver function and low cardiac output are vulnerable to systemic toxicity. When performing regional anesthesia, the guideline-directed monitoring, securing a venous line, preparation of medication to treat convulsions and lipid emulsions are required. For prevention of local anesthetic systemic toxicity, small-dose, divided administration, using agents with low toxicity such as ropivacaine and levobupivacaine, performing an aspiration test are recommended. If systemic toxicity is suspected, halt administration of local anesthetic, request assistance, secure venous line, airway, administration of 100% oxygen and if necessary tracheal intubation and artificial respiration should be immediately performed. Benzodiazepines are recommended to treat convulsions. Administration of 20% lipid emulsion according to the protocol is recommended to treat severe hypotension and arrhythmia.

LO12: The utility of femoral nerve blocks in the emergency department; a national survey of practice

Introduction: Approximately 30,000 hip fractures occur annually in Canada, and the incidence will increase with an aging population. Pain control remains a challenge with these patients, as many are elderly and prone to delirium. Regional anesthesia has shown to be very effective with minimal risks, but it is not clear how often emergency physicians are using this technique to provide analgesia for patients with proximal hip fractures. This is the first Canada-wide survey to evaluate the use of regional anaesthesia in the emergency department for hip fractures. It also evaluates physician comfort level with performing these blocks, perceived educational needs in this area, and barriers to performing nerve blocks. Methods: A 13-question survey was sent to 1041 members of the Canadian Association of Emergency Physicians via email in January and February of 2016. Data was collected and analysed using an online collection program called “Survey Monkey”. Ethics approval was obtained through the University of Manitoba Research Ethics Board. Results: 272 Emergency physicians and residents took part in the survey. The majority of respondents (75.9%) choose intravenous opioids as their first line of analgesia and only 7.6% use peripheral nerve blocks (PNB) as their first line choice for analgesia in hip fracture. In response to practitioner comfort with PNBs for hip fractures, most were not at all confident (45.0%) in their ability and many respondents have never performed a nerve block for a hip fracture (53.9%). The most commonly identified barriers to performing PNBs include lack of training, the time to perform the procedure and a lack of confidence. A larger percentage of respondents (34.2%), identified having had no training and no knowledge of how to perform PNBs for hip fractures. Conclusion: The vast majority of Canadian emergency physicians who took part in this survey do not utilize PNBs as a method of pain management for hip fractures. Over half have never performed one of these procedures and many have never received training in how to do so. Future efforts should focus on improving access to education, disseminating information regarding the effectiveness of PNB, and addressing logistical barriers in the ED.

Effect of dexmedetomidine-assisted continuous femoral nerve block analgesia after total knee arthroplasty (TKA)

Objective To investigate the effects of dexmedetomidine on ropivacaine for continuous femoral nerve block (CFNB) analgesia after total knee arthroplasty (TKA). Methods Forty patients after TKA were randomly assigned into two groups of T and C (n=20 cases each group). All of the patients received spinal-epidural combined anesthesia, subarachnoid injection of 0.5% isobaric ropivacaine 3 ml, intraoperative epidural space according to the need of surgery an extra 0.375% ropivacaine paid for 3 to 5 ml. Postoperative analgesia with continuous femoral nerve block was performed in both groups, after the puncture of femoral nerve, group T was injected with 0.375% ropivacaine + dexmedetomidine mixed solution 20 ml (with dexmedetomidine 0.6 μg/kg), group C were injected with 0.375% ropivacaine 20 ml. Placement of continuous femoral nerve catheter, two groups of patients were performed operation continuous femoral nerve block analgesia and CFNB with 0.75% ropivacaine 50 ml, added saline diluted to 200 ml (each bag). Background infusion was 4 ml per hour; the demand dose was 4 ml in a lockout interval of 30 minutes. Two groups of patients were recorded rest visual analogue scale (RVAS) and passive visual analogue scale (PVAS) postoperative 6, 24, 48 and 72 h. Serum concentration of tumor necrosis factor-α (TNF-α), interleukin(IL)-1β and IL-6 were measured with double sandwich enzyme-linked immunosorbent assay (ELISA) method before anesthesia and postoperative in 24, 48, and 72 hours. Analgesia-related adverse reactions such as delirium, nausea and vomiting, urinary retention were record. Results Compared to group C, postoperative RVAS and PVAS of 6, 24 and 48 h wrere significantly decreased (P<0.05). Postoperative serum concentrations of TNF-α, IL-1β and IL-6 in 24, and 48 hours in group T were lower than those in group C (P<0.05). Group T incidence of postoperative sinus bradycardia was lower than the group C (P<0.05). Conclusions Dexmedetomidine combined with ropivacaine analgesia may effectively improve the TKA postoperative analgesic effect of CFNB, to reduce the levels of serum inflammatory factors, and depress stress reaction after operation. Key words: Dexmedetomidine/AD; Procaine/AD; Femoral nerve; Nerve block; Arthroplasty, replacement, knee; Analgesia

Ultrasound guidance for upper and lower limb blocks.

Ultrasound guidance for upper and lower limb blocks.

Exacerbation of spasticity in ipsilateral shoulder after right brachial plexus block in a patient with right hemiplegia

Spasticity is a common impairment in patients with central nervous system disease. Clinical observation has demonstrated that spasticity can be aggravated by various factors such as emotional state as well as noxious stimuli. A 51-year-old male patient was scheduled for arteriovenous fistula surgery. He had right hemiplegia including motor weakness and spasticity. It was decided that the surgery would be performed under an axillary brachial plexus block (BPB). He appeared nervous when blockade was terminated. The spasticity of the right shoulder increased after ipsilateral BPB. However, when we administered sedative drugs and performed interscalene BPB 2 days later, spasticity did not occur. Exacerbation of spasticity might be evoked by an anxious emotional state. Thus, it seems to be good to consider removing of anxiety and using an appropriate approach when it is tried to perform nerve blocks in individuals with spasticity.