Peripheral Blocks Research Articles

Разработка микроконтроллерного FMU ядра на базе ПЛИС для научной космической аппаратуры

A FMU (Flexible Microcontroller Unit) model of the core of a domestic FPGA is proposed with the purpose of obtaining characteristics superior in speed and type of data processing over modern domestic and foreign microcontrollers. The FMU core and its corresponding peripherals are designed on FPGA, which makes the architecture of the entire microcontroller flexible and allows its characteristics to be varied without the need to acquire other chips. The entire architecture is a single configuration file, written in the Verilog HDL and combining the core and peripheral blocks. At the request of the user, the number of peripheral modules сan be either increased or reduced. Parallel (multicore) data processing is also available, which function is absent in modern microcontrollers. The program for the configured microcontroller is written in a C-style language, which is converted into a binary package of a program loaded separately into the program memory of the microcontroller in question. To convert the source code into such a package, a corresponding C++ compiler was developed. The paper provides a block diagram of the kernel architecture, time diagrams of various packages and instructions, as well as a list of kernel commands. The test results presented in the paper demonstrate small time expenditures on executing some instructions for working with internal and external RAM. Conclusions are formulated and brief characteristics of the core are given.

The Use of Pericapsular Nerve Group (PENG) Block in Hip Surgery

Introduction: Pericapsular nerve group (PENG) block is a recently introduced pain control method indicated for hip fracture. Anterior capsule is the most abundantly innervated site of the joint. Therefore, unlike the common performed peripheral block, PENG block was proposed to provide a complete analgesia. Objective: This systematic review aims to evaluate the effect of PENG block in hip fracture surgery and hip arthroplasty. Methods: A comprehensive search was conducted in PubMed, ScienceDirect, and ClinicalKey databases until July 31st 2022 with the following keyword: “pericapsular nerve group block”. Results: Nine studies were included in the final qualitative synthesis. Compared to most commonly performed peripheral nerve blocks (femoral nerve block (FNB) or fascia iliac compartment block (FICB)), the PENG block seemed to offer better pain control (three studies reported better post-operative pain score (VAS) and one showed immediate pain improvement at 10, 20, and 30 minutes after block). The PENG block also increased the period of analgesic-free window and lowered the amount of opioid use. Mobility and length of stay were reported superior in PENG block. A study comparing PENG block with periarticular infiltration also reported lower cumulative opioid consumption, although it is not significant. In one study, PENG block was compared with no block and resulted in significantly better post-operative pain, lesser opioid dose, longer time to first opioid need, and better mobility. If not fewer, adverse events were comparable in PENG block than other techniques. Conclusion: Pericapsular nerve group block appears to have beneficial effects in hip surgery. This analgesic method may provide better outcomes in pain control, use of opioid, mobility, and length of hospital stay. However, future studies are expected to confirm these results.

BILATERAL TRANSVERSUS ABDOMINIS PLANE BLOCK REDUCES POSTOPERATIVE NSAIDS USE AFTER LAPAROSCOPIC HERNIA REPAIR

INTRODUCTION: Bilateral peripheral block (TAP - block) is usually performed under ultrasonography (US) guidance in the plane between the inner oblique abdominal muscle and the transversal abdominal muscle, and it aims to block the thoracoabdominal nerves from Th6 to L1 by infiltrating local anesthetic. TAP block is effective tool of managing pain control, especially in the first twenty-four hours after surgery. It improves recovery pathway following minimally invasive surgery and reduces narcotic and non-steroidal anti-inflammatory drugs (NSAIDs) use for postoperative pain management in various different abdominal surgery. AIM: The purpose of this research was to assess the analgesic efficacy of TAP block in regard to used NSAIDs concentrations during the first 24 hours following laparoscopic inguinal hernioplasty. METHODS: The study was conducted with 60 patients, who were randomized into two groups. Control group – were patients who received general anesthesia (GA), and experimental group, were patients who have received GA and a bilateral TAP block. All patients received NSAIDs in the postoperative period. RESULTS: From the acquired data, during the first postoperative hour (POH) only 20% of the experimental group required Paracetamol in a dosage of 1000 mg. Control patients used three times more NSAIDs (60%). Compared to the control group, 63.3% of TAP-block patients did not require analgesia from the 6th to the 12th POH. In the control group average amount of paracetamol was 5167 mg, while in experimental group it was twice lower. Similar finding was established in regard to Ketonal consumption. The control group (without TAP-block) consumes around twice as many NSAIDs as the experimental group at all post-operative time intervals. CONCLUSION: The findings of our research demonstrate that patients undergoing bilateral laparoscopic inguinal repair, administering ropivacaine as part of an US-guided bilateral TAP-block decreases the requirement of NSAIDs in the first twenty-four hours after surgery. TAP-block is a component of multimodal anesthesia and an adjuvant for intraoperative and postoperative analgesia.

Comparison of clinical efficacy of subchondral blocking technique combined with plate-screw biplanar fixation and simple plate-screw support peripheral block fixation in the treatment of complex posterior wall acetabular fracture

To investigate the clinical effect of subchondral blocking technique combined with plate and screw biplane fixation in the treatment of complex acetabular posterior wall fractures. From July 2015 to December 2019, a total of 47 cases of acetabular posterior wall fractures were treated. According to the different internal fixation techniques, they were divided into the external blocking fixation group supported by lateral plate and screw(control group of 23 cases) and the subchondral blocking technique combined with lateral plate and screw support biplane fixation group(study group of 24 cases). In the control group, there were 15 males and 8 females, aged 18 to 68 years old with an average of (40.9±7.2) years;preoperative preparation was 4 to 13 days with an average of (7.9±1.5) days. In the study group, there were 14 males and 10 females, aged 20 to 71 years old with an average of (41.7±7.9) years;preoperative preparation was 4 to 12 days with an average of (7.5±1.9) days. Kocher-Langenbeck approach was used in both groups and all patients were followed up for at least 1 year. The operation time, intraoperative blood loss, hospitalization time, quality of fracture reduction after operation, modified Merle D'Aubigne Postel score of hip joint one year after operation and postoperative complication rate of two groups were statistically analyzed and compared. The patients in both groups were followed up for at least 1 year. One year after operation, the Merled'Aubigne Postel score(16.042±1.517) of hip function improvement in the study group was significantly higher than that in the control group (14.696±1.222)(P<0.05). There was no significant difference in operation time and intraoperative bleeding between the two groups(P>0.05). One year after operation, there was a significant difference between two groups in the evaluation results of Matta fracture reduction quality(P<0.05). There was no significant difference in postoperative complications between two groups(P>0.05). The treatment of complex acetabular posterior wall fracture with subchondral blocking technique combined with plate and screw biplane fixation technique has lower postoperative complication rate, better functional recovery of hip joint and satisfactory clinical effect.

Effects of Peripheral Neural Blocks in Laparoscopic Sleeve Gastrectomy: a Pilot Study on Cognitive Functions in Severe Obese Patients

BackgroundIn addition to the analgesic effect, peripheral neural blocks also prevent cognitive impairment and peripheral inflammation induced by surgery. However, it is unknown if there is collateral impact on cognitive improvement after bariatric surgery.MethodsIn this pilot study, 75 patients with severe obesity for selective laparoscopic sleeve gastrectomy (LSG) were recruited and randomized into three groups (1:1:1) as general anesthesia (GA) group, transverse abdominis plane block (TAPB) group, and quadratus lumborum block (QLB) group. Bilateral TAPB or QLB was performed (0.33% ropivacaine with dexmedetomidine 1 μg/kg) before the standardized general anesthesia. Cognitive test battery was completed before LSG and in 1-month and 3-month follow-up. The levels of peripheral inflammatory cytokines were determined at equivalent time points.ResultsPatients with LSG exhibited massive cognitive improvement in postoperative 3 month without or with TAPB or QLB (Ptime < 0.001). Compared to GA, QLB significantly strengthened performance in MoCA (β = 0.56, 95%CI: 0.08, 1.05). IL-6, IL-8, and high-sensitivity CRP significantly verified among three groups. Changes in IL-6 within postoperative 3 months were negatively correlated with MMSE and MoCA, and positively correlated with AVLT-DR for QLB group. Similar correlation was found in the GA group for changes in IL-6 and AVLT-IR.ConclusionLaparoscopic sleeve gastrectomy ideally improved memory and attention as early as postoperative 1 month. QLB promoted cognitive improvement in MoCA, which was negatively correlated with changes in IL-6. More precise trials are needed to determine the overall effect of peripheral neural block on cognition following bariatric surgery.Graphical

Радиационно-стойкие СБИС СнК и ОЗУ — особенности проектирования по КМОП технологиям объемного кремния

The effect of various types of radiation and heavy nuclear particles on VLSI fabricated using CMOS technologies for bulk silicon at a level of 250–90 nm is analyzed. Developed and certified on test crystals (TC) are constructive-topological and circuit solutions for elements of digital libraries, complex-functional RAM blocks and peripheral mixed-signal blocks for designing radiation-hardened VLSI of the “system-on-chip” (SoC) type and RAM of category RT (products with an increased level of radiation resistance). The methodology of radiation-hardened by design (RHBD) has been further developed. For CAD tools, a design environment for VLSI of the RT category was created for manufacturing at Russian factories using available CMOS bulk technologies. Based on this design environment, competitive radiation-hardened high-performance processor CMOS VLSI SoC and VLSI RAM were created. Basic technical solutions are protected by RF patents.

AAOS Management of Hip Fractures in Older Adults Evidence-based Clinical Practice Guideline.

AAOS Management of Hip Fractures in Older Adults Evidence-based Clinical Practice Guideline.

Ultrasound-guided and Peripheral Nerve Stimulator-guided Interscalene Brachial Plexus Block in a Patient with Neurofibromatosis during the COVID-19 Pandemic

An 18-year-old female with neurofibromatosis presented for enucleation biopsy of a slow-growing soft tissue masson her right anteromedial arm during the COVID-19 pandemic. Ultrasonography was used in the mapping of thebrachial plexus and the identification of possible neurofibroma along peripheral nerves. An interscalene brachialplexus nerve block was successfully and safely achieved with ultrasonographic and peripheral nerve stimulatorguidance. Ultrasound-guided and nerve stimulator-guided peripheral nerve blocks are safe and viable anestheticmanagement options for patients with neurofibromatosis, especially in this time of the COVID-19 global pandemic.

Pre-emptive ultrasound-guided transversus abdominis plane block in open appendicectomy

Background Transversus abdominis plane (TAP) block is a newly effective peripheral block which involving mainly the nerves of the anterior abdominal wall in lower abdominal surgery. The present study aimed to evaluate the postoperative analgesic efficacy of right-sided ultrasound guided TAP block by using 20 millimeters of bupivacaine 0.25% in patients undergoing open appendicectomy. Patients and methods After taking informed consent, fifty patients (ASA I and II) undergoing open appendicectomy were randomized into 2 groups (25 each). After induction of general anesthesia; Group B received right side ultrasound guided TAP block using 20 ml bupivacaine 0.25%. Group S (standard group) received general anesthesia without TAP block. Postoperative analgesia by ketorolac and paracetamol was given as required. Postoperative VAS at rest and movement, intra and post operative hemodynamics, analgesic requirements and their side effects were recorded for 24 hours. Results A significant reduction of VAS up to twelve hours postoperatively detected in the TAP block group with bupivacaine 0.25%. There was also significant elongation of time to the first analgesia, significant reduction in number of rescue analgesics, as will as there were significant decrease in nausea, vomiting and pruritus between two groups. Conclusion Right-sided ultrasound guided TAP block using 20 ml of bupivacaine 0.25% had effective postoperative analgesia for twelve hours after the open appendicectomy.

A comprehensive study of the abdominal ganglia part 3: An overview of the most commonly observed ganglion patterns.

Chronic pain from untreatable abdominal cancers or pancreatitis can severely decrease an individual's quality of life due to accompanying neuropathic pain, the most difficult pain mechanism to treat. Current treatment modalities focus on peripheral block or neurolysis procedures of the sympathetic ganglia in an attempt to curb the pain and improve quality of life. Reports indicated that these treatments are ineffective with patients either experiencing no relief or return the pain in a few weeks. The aim of this study was to investigate the location, macro- and microscopic morphology, and interconnections of the abdominal ganglia. The abdominal sympathetic ganglia of nine adult cadavers were investigated. The locations, morphology, interconnections, and microscopic structure were studied in 108 potential abdominal ganglia. Particular emphasis was placed on direct interconnectivity between the ganglia and histological morphology. A total of 100 ganglia were confirmed histologically to contain ganglion cells. The number and locations of most of the ganglia identified in our study does not correspond to that described by previous reports. Numerous interconnections between the different ganglia, as well as direct communications with the lumbar sympathetic chain ganglia were observed. The interconnections and presence of ganglion cells the nerves connecting the ganglia lead to the belief that the system should be considered as a unit and that pain fibers may be transmitted via alternative previously undiscovered pathways. If the pain treatments are to be reassessed with this information in mind, we believe that greater success could be achieved.

Antithrombotic drugs and the risk of bloody punctures in regional anesthesia - a retrospective registry analysis

IntroductionThe risk of bleeding during regional anesthesia implementation in patients on antithrombotic therapy remains poorly characterized. We; therefore, analyzed bloody tap rates and adjusted ORs comparing patients who take antithrombotic...

Choice of Anesthesia for Orthopedic Surgery in Elderly and Senile Patients (Review)

Management of elderly and senile patients is a major challenge due to significant comorbidity, especially in surgery under general anesthesia.The aim of the review was to identify the optimal method of anesthesia for knee arthroplasty in elderly patients based on the available clinical and experimental studies.We searched PubMed, Medline, and Elibrary.ru databases for relevant sources. Out of more than 300 publications initially analyzed, 113 literature sources (dating from 1951 to 2021) were included in the review, of which 80 were published within the last five years (2016–2021). The inclusion criteria were high informative value and relevance, except for sources cited as historical references. Both randomized multicenter studies and individual case reports were included in the review. Exclusion criteria were low informative value, outdated and repetitive data.We reviewed the physiology of elderly and senile patients, various variants of anesthesia, the use of neuroaxial anesthesia and peripheral regional blocks, xenon-based general anesthesia, assessed the advantages and drawbacks of each method, and discussed the monitoring of the depth of anesthesia and the issues of inraoperative awareness during knee arthroplasty in elderly and senile patients.Conclusion. The choice of anesthesia for knee arthroplasty in elderly and senile patients should be based on the risks of decompensation of cardiovascular comorbidities and cognitive impairment. No known anesthetic method is ideal in terms of safety. The use of xenon as the main anesthetic seems promising due to its cardio- and neuroprotective properties. However, its use is limited due to relatively high cost. Therefore, the search for optimal (lower than recommended) inhalation concentrations may lead to expanding use of xenon in elderly and senile patients. At the same time, the use of lower concentrations of the drug is associated with the intraoperative awakening and the need for its combination with narcotic analgesics or amnestic agents, which may not be optimal. In addition, the protective effect of xenon retrograde amnesia against the stress of unintended intraoperative awakening has not been studied, and routine methods of monitoring the depth of hypnosis when using xenon often yield skewed measurement results inconsistent with the clinical manifestations of anesthesia.Therefore, there is a need for further studies concerning the retrograde amnesic effect of xenon and search for optimal methods of assessing the depth of hypnosis when using this gas to safely reduce its inhalation concentration.

Update on Interventional Management of Neuropathic Pain: A Delphi Consensus of the Spanish Pain Society Neuropathic Pain Task Force.

Background and Objectives: Interventional management of neuropathic pain (NP) is available to the patients who do not obtain satisfactory pain relief with pharmacotherapy. Evidence supporting this is sparse and fragmented. We attempted to summarize and critically appraise the existing data to identify strategies that yield the greatest benefit, guide clinicians, and identify areas that merit further investigation. Material and Methods: A two-round Delphi survey that involved pain clinic specialists with experience in the research and management of NP was done over an ad hoc 26-item questionnaire made by the authors. Consensus on each statement was defined as either at least 80% endorsement or rejection after the 2nd round. Results: Thirty-five and 29 panelists participated in the 1st and 2nd round, respectively. Consensus was reached in 20 out of 26 statements. There is sufficient basis to treat postherpetic neuralgias and complex regional pain syndromes with progressive levels of invasiveness and failed back surgery syndrome with neuromodulation. Radiculopathies and localized NP can be treated with peripheral blocks, neuromodulation, or pulsed radiofrequency. Non-ablative radiofrequency and non-paresthetic neuromodulation are efficacious and better tolerated than ablative and suprathreshold procedures. Conclusions: A graded approach, from least to most invasive interventions has the potential to improve outcomes in many patients with common refractory NP conditions. Preliminary promising data warrant further research on new indications, and technical advances might enhance the safety and efficacy of current and future therapies.

Simulation-Based Medical Education and Training Enhance Anesthesia Residents' Proficiency in Erector Spinae Plane Block.

BackgroundAdvances in regional anesthesia and pain management led to the advent of ultrasound-guided fascial plane blocks, which represent a new and promising route for the administration of local anesthetics. Both practical and theoretical knowledge of locoregional anesthesia are therefore becoming fundamental, requiring specific training programs for residents. Simulation-based medical education and training (SBET) has been recently applied to ultrasound-guided regional anesthesia (UGRA) with remarkable results. With this in mind, the anesthesia and intensive care residency program of the University of Milano-Bicocca organized a 4-h regional anesthesia training workshop with the BlockSim® (Accurate Srl, Cesena) simulator. Our study aimed to measure the residents' improvement in terms of reduction in time required to achieve an erector spinae plane (ESP) block.MethodsFifty-two first-year anesthesia residents were exposed to a 4-h training workshop focused on peripheral blocks. The course included an introductory theoretical session held by a locoregional anesthetist expert, a practical training on human models and mannequins using Onvision® (B. Braun, Milano) technologies, and two test performances on the BlockSim simulator. Residents were asked to perform two ESP blocks on the BlockSim: the first without previous practice on the simulator, the second at the end of the course. Trainees were also also asked to complete a self-assessment questionnaire.ResultsThe time needed to achieve the block during the second attempt was significantly shorter (131 [83, 198] vs. 68 [27, 91] s, p < 0.001). We also observed a reduction in the number of needle insertions from 3 [2, 7] to 2 [1, 4] (p = 0.002), and an improvement aiming correctly at the ESP from 30 (58%) to 46 (88%) (p < 0.001). Forty-nine (94%) of the residents reported to have improved their regional anesthesia knowledge, 38 (73%) perceived an improvement in their technical skills and 46 (88%) of the trainees declared to be “satisfied/very satisfied” with the course.ConclusionsA 4-h hands-on course based on SBET may enhance first-year residents' UGRA ability, decrease the number of punctures and time needed to perform the ESP block, and improve the correct aim of the fascia.

Peripheral nerve block of the dorsal cranium in two dogs undergoing craniotomy

AbstractTwo adult medium‐sized dogs presented with generalised tonic‐clonic seizures associated with meningiomas, one affecting the right parietal lobe and the other both frontal and olfactory lobes. Both underwent craniotomy and received multimodal anaesthetic protocols, including a peripheral nerve scalp block (frontal, zygomaticotemporal and major occipital nerves) based on a previous cadaveric study. For one dog, an intraoperative magnetic resonance imaging was performed; the bupivacaine block wore off after 280 minutes and was repeated with good effect before surgery resumed. The second dog had dexmedetomidine added to bupivacaine at the outset. The block lasted, as judged by pain assessment, at least 6 hours. We found that regional anaesthesia of the scalp was manageable to perform in a timely manner, showed good perioperative clinical effect and was likely prolonged by the addition of dexmedetomidine.

Retrospective Evaluation of Anesthesia Experience at a Training and Research Hospital in Turkey

This study aims to evaluate retrospectively the two-year data of our clinic concerning the effects of training for reduced fresh gas flow anesthesia applications, the demographic data of patients, the types of anesthesia performed, non-operating room anesthesia applications and the incidences of admission to the post-anesthesia care unit. Hospital archives on anesthesia services of 2016-2017 were scanned. The acquired data were analyzed retrospectively with yearly comparisons on the bases of the consumed amount of inhalation anesthetics, distribution of the peripheral blocks according to the surgical sections, the number of patients operated outside the operating room and sent to the post-anesthesia care unit. The number of operations carried out in our hospital was 22533 in 2016 and 24634 in 2017. High flow anesthesia in 2016 and low flow anesthesia in 2017 were found statistically high (P &lt; 0.001). In 2016 and 2017, neuraxial block cases were used in 76.24% and 76.19% of the cesarean section, 4936and 7152 patients underwent anesthesia outside of the operating room; 405 and 816 patients were sent to the post-anesthesia care unit, respectively. In 2017, the consumption of inhalation agents decreased after regular training on the reduced fresh gas flow technique. In 2017, the increase observed in peripheral block applications was based on the increase in ultrasound experience in our clinic. We recommend a combination of reduced fresh gas flow with peripheral or neuraxial blocks to achieve multimodal general anesthesia.

Evaluation of the effectiveness duration of peripheral blocks applied with high concentration local anesthetic and steroid in trigeminal neuralgia.

The aim of this study was to investigate the effectiveness duration of the peripheral blocks applied with high concentration local anesthetic and steroid in trigeminal neuralgia. The data of 48 patients (nine patients received medical treatment and 39 patients underwent interventional procedure for peripheral block and Gasser ganglion radiofrequency thermocoagulation [RFT]) were analyzed retrospectively. The medications used by patients, pre-operative and post-operative visual analog scale scores who underwent interventional procedures, and duration for effectiveness of the procedure were evaluated with 36 months follow-up. Forty-eight patients (32 females and 16 males) who were treated with primary and secondary etiologies were evaluated. Three patients V1, 12 patients V2, 25 patients V3, and eight patients V2+V3 trigeminal nerve branches described appropriate clinical symptoms. Only peripheral block was applied to 31 patients and Gasser ganglion RFT was applied to eight patients after peripheral block. In 24 patients who underwent peripheral block, pain severity reduction was ≥50%, mean effectiveness duration of peripheral block was 7.5 months. The eight patients undergoing Gasser ganglion RFT had ≥50% pain intensity reduction, mean effectiveness duration of Gasser ganglion RFT was 22.7 months (p=0.002). While one patient had hypoesthesia in the palate after RFT, no serious side effects were recorded. The duration of pain control for peripheral branch blocks in trigeminal neuralgia is not as long as RFT, but it is a relatively less invasive and less complicated interventional technique with good efficacy duration due to neurotoxicity of the used high concentrated local anesthetic.

A New Diagnostic and Therapeutic Method for the Conservative Management of Sciatica

Background: The term “Sciatica” is commonly used for describing nerve pain in the leg which is caused due to the irritation or compression of the sciatic nerve. It is a source of disability and can interfere with the physical occupation aspect. Estimates for the lifetime incidence of sciatica range from 13% to 40%. Two common nonsurgical interventions used are physical therapy and epidural steroid injections. Pain is regulated by a subset of voltage-gated sodium channels, (NaV1.3, NaV1.7, NaV1.8, and NaV1.9). For this character of sodium channels in neurological pain, a peripheral nerve block is an upcoming treatment other than conventional treatment options such as steroid injections or opioids, analgesics. Methods: We conducted a randomized placebo-controlled trial in which after the application of injection we compared Visual Analog Scale Score, subjective satisfaction scale, straight leg raise (SLR) test preinjection and postinjection at 10 min, 1 week, and at 1 month. Results: In our study, a total of 92 patients were taken for the study: 66 patients in drug mixture group and 26 patients in the placebo group. The present study showed relief from pain up to the maximum follow-up period of 1 month; it also showed improvement in the SLR and also a better patient satisfaction, without any complications. Conclusion: In conclusion, peripheral sodium-channel block can be considered as a diagnostic as well as an option for short-term relief from pain in the patient suffering from sciatica, allowing physiotherapy, and rehabilitation exercises.

Efficacy of perineural versus intravenous dexamethasone in prolonging the duration of analgesia when administered with peripheral nerve blocks: a systematic review and meta-analysis.

BackgroundPerineural dexamethasone has been regarded as a promising adjunct for prolonging the duration of nerve blocks. However, it is uncertain whether its effects are due to local effects on the nerves or from systemic absorption. This systematic review aimed to compare the duration of postoperative analgesia associated with perineural versus intravenous dexamethasone as an adjunct to peripheral nerve blocks. MethodsA total of 2,216 relevant academic articles were identified after a comprehensive search of PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from 1967 until 2020. All randomized controlled trials that compared perineural and intravenous dexamethasone as adjuncts to peripheral nerve limb blocks were included.ResultsFifteen randomized controlled trials (1,467 cases; 738 perineural dexamethasone, 729 intravenous dexamethasone) were eligible. The primary outcome (duration of analgesia) was significantly longer in the perineural than in the intravenous dexamethasone group (mean difference [MD]: 2.72 h, 95% CI [1.42, 4.01], P < 0.001). Perineural dexamethasone was also found to prolong the sensory block (MD: 3.45 h, 95% CI [1.36, 5.54], P = 0.001) and lower 24 h postoperative pain scores (MD: −0.74 h, 95% CI [−1.40, −0.07], P = 0.03).ConclusionsThis review confirms the greater efficacy of perineural compared to intravenous dexamethasone in prolonging the analgesic duration of peripheral nerve blocks. However, the extent of prolongation was small and may not represent a clinically meaningful difference.

Evaluate the quality of successful ultrasound guided supraclavicular brachial plexus block and its correlation with perfusion index ratio

Background: Ultrasound-guided supraclavicular nerve block is a popular approach for anesthesia for upper limb surgeries. Perfusion index can considered as an objective measure for peripheral perfusion that can predict peripheral block success. Early and accurate detection of peripheral block success would enable rapid corrective action this would save the operating room time and improve patient satisfaction. The main objective was to evaluate the quality of supraclavicular brachial plexus block and it’s correlation with Perfusion Index ratio. Method: It was a prospective observational study carried out over a period of 18 months from November 2018 to April 2020 in the department of anesthesia. Patients aged between 18 to 65 years. Written informed consent, 30 patients of either sex, belonging to ASA grade I and II, scheduled for elective upper limb, under supraclavicular brachial plexus block were selected for the study. Quality of block was made on the basis of 3 point scale. Result: In this study we observed that the Perfusion index was significantly higher in blocked limbed at all time points.