Nerve Block Techniques Research Articles

Combining Pericapsular Nerve Group (PENG) Block With the Supra-Inguinal Fascia Iliaca Block (SIFICB) for Perioperative Analgesia and Functional Recovery in Patients Undergoing Hip Surgeries: A Retrospective Case Series.

The complex innervation of the hip joint may require a combined peripheral nerve block technique for perioperative effective analgesia and early recovery. The pericapsular nerve group (PENG) and suprainguinal fascia iliaca compartment blocks (SIFICB) are interfascial plane blocks aiming to involve the femoral, obturator, accessory obturator, and lateral femoral cutaneous nerves. The data still lacks in providing the standard of care for patients undergoing hip surgery. In this case series, we studied the efficacy of ultrasound-guided combined PENG block and SIFICB for perioperative analgesia and functional recovery in patients posted for hip surgery. We studied 10 adults of either gender who underwent close reduction and internal fixation of hip fracture. Before receiving spinal anesthesia, all patients had PENG block and SIFICB with 10 ml and 20 ml of local anesthetics respectively. Patients were observed for ease of giving sitting position for spinal anesthesia (EOSP), visual analogue score (VAS) at rest and 15° leg elevation, duration of postoperative analgesia, the cumulative requirement of rescue analgesic at 48 hours and ability of patients to undergo weight-bearing trial postoperatively. The static and dynamic VAS before receiving spinal anesthesia and postoperatively, was reduced compared to pre-block. The optimal position for delivering spinal anesthesia was possible to achieve as the patients were able to sit comfortably after 10 minutes of receiving both blocks. Duration of postoperative analgesia also extended up to 18 hours with the cumulative requirement of injection tramadol restricted to two doses postoperatively. All were able to walk down a minimum of 55 steps after 48 hours of completion of surgery. Combining PENG block along with SIFICB is effective in the provision of perioperative analgesia with a considerable reduction in opioids and enhanced functional recovery due to motor sparing effect after surgical repair of the hip fracture.

Does a New Modification of the Two-Step Injection Technique for Inferior Alveolar Nerve Block Reduce Pain Compared to the Conventional Technique? A Randomized Clinical Trial.

The ability to control pain is an essential part of dental procedures and the need for optimal pain control and reduction of discomfort is the primary concern of every dentist. This study aims to compare the pain and vital signs during inferior alveolar nerve block between conventional and a new modification of the two-step injection techniques. In this institutional single-blind randomized clinical trial, attendees of dental school at Mazandaran University of Medical Sciences from February to May 2022 were included. Inclusion criteria were 20-60 years old and healthy (ASA1) individuals who were willing to participate in this study. Individuals who were taking medications affecting their understanding of pain and patients with active infections at the injection site were excluded. These individuals were divided into two groups. First, superficial anesthesia was performed and afterward, conventional and two-step injection techniques were performed. For the two-step injection method, 6 mm of the needle was injected into the mucosa and one-third of the local anesthetic solution was released from the computer-controlled injection toolkit. Afterward, a 25 mm 30-gauge needle was reinserted into the previous hole delivering the remaining local anesthetic. The pain during injection was measured by a patient-reported numerical rating scale (NRS). Moreover, vital signs were monitored immediately before and after the injection. Kolmogorov-Smirnov test, Mann-Whitney U test, independent T-test, and Fisher's exact χ 2 test were performed for statistical analysis (α = 0.05). This study involved 32 adults aged between 20 and 50 years old with 1 : 1 female/male sex distribution. The pain score was significantly higher in the conventional injection technique compared to the two-step injection technique in all sex and age groups. There were no significant differences in vital signs between the conventional and two-step injection techniques. There was no significant difference in the mean pain scores of females and males, regardless of their injection techniques. Utilizing the two-step injection technique in patients for inferior alveolar block reduces pain during injection without altering patients' vital signs significantly. This trial is registered with IRCT20220106053646N1.

Analgesic efficacy of inter-semispinal fascial plane block in Patients undergoing Cervical Spine Surgery through Posterior Approach: a randomized controlled trial

BackgroundPosterior cervical spine surgery is commonly performed in elderly patients with significant comorbidities and is considered one of the most painful surgical procedures. Accordingly, perioperative pain management during posterior cervical spine surgery represents a unique challenge for anesthesiologists. Inter-semispinal plane block (ISPB) represents a promising analgesic technique for spine surgery through the blockade of the dorsal rami of the cervical spinal nerves. The present study aimed to investigate the analgesic effect of bilateral ISPB as an opioid-sparing nerve block technique for posterior cervical spine surgeries. MethodsThis prospective randomized controlled trial enrolled 52 patients planned for cervical spine surgery via the posterior approach. Patients were randomly assigned to one of two groups in a one-to-one ratio, with 26 patients allocated to the block group (ISPB) who received general anesthesia preceded by bilateral ISP using 20 mL 0.25% bupivacaine on each side and the remaining 26 patients allocated to the control group who received general anesthesia only. The primary outcome was total perioperative opioid consumption through two co-primary outcomes, i.e. total amount of fentanyl administered intraoperatively and total morphine consumption during the first 24 hours postoperatively. The secondary outcomes included intraoperative hemodynamic parameters, assessment of numerical rating scores (NRS) during the first 24 hours postoperatively, time to first rescue analgesia and opioid-related side effects. ResultsA significantly lower amount of intraoperative fentanyl was administered in the ISPB group (median, 175 μg; range, 110–220 μg] compared to the control group [median, 290 μg; range 110–350 μg). Patients in the ISPB group consumed significantly lower doses of morphine (median, 7 mg; range, 5–12 mg]) within the first 24 h postoperatively compared to the control group (median, 12 mg; range, 8–21 mg). In addition, NRS values were significantly lower in the ISPB group during the first 12 h postoperatively than in the control group. No significant differences in mean arterial pressure (MAP) or heart rate (HR) were observed between intraoperative time points in the ISPB group. However, a significant increase in MAP was observed during surgery in the control group (p < 0.001). The incidence of opioid side effects such as nausea, vomiting, and sedation was significantly greater in the control group compared to the ISPB group. ConclusionsInter-semispinal plane block (ISPB) represents an effective analgesic technique and reduces opioid consumption in both intra- and postoperative settings. Moreover, the ISPB could significantly decrease opioid-associated side effects.

Peripheral Nerve Block Practice in Portugal: A National Survey.

Regional anesthesia (RA) has several benefits and its use has increased with the advent of ultrasound-guided techniques. Opioid-sparing anesthesia and reduced use of general anesthesia are some of the mainstay advantages of RA. Although anesthetic practices differ deeply between countries, RA has assumed a crucial role in the daily practice of anesthesiologists, particularly during the COVID-19 pandemic period. This cross-sectional study provides an overview of peripheral nerve block (PNB) techniques performed in Portuguese hospitals. An online survey was reviewed by members of Clube de Anestesia Regional (CAR/ESRA Portugal) and then sent to a national mailing list of anesthesiologists. The survey focused on specific topics related to RA techniquessuch as the importance of training and experience, and the relevance of logistical limitations during the execution of RA. All data were collected anonymously and included in a Microsoft Excel (Microsoft Corp., Redmond, WA, USA) database, for further analysis. A total of 335 valid answers were obtained. All participants considered RA as a key competence in their daily practice. Half of those inquired performed PNB techniques once to twice per week. The main limitations identified for performing RA in Portuguese hospitals were the absence of block rooms and insufficiently trained personnel for the appropriate and safe execution of these techniques. This survey provides a comprehensive overview of RA in the Portuguese setting and could serve as a baseline for further studies.

Outcomes of Ultrasound Guided Versus Cystoscopy Guided Obturator Nerve Block (Obn) In Transurethral Resection Of Bladder Tumour (Turbt)

Context: Selective obturator nerve block (ONB) limits obturator reflex, adductor contraction, and leg jerking in transurethral resection of bladder tumour (TURBT), which ultimately prevents complications such as bleeding, bladder perforation, or incomplete tumor resection. The present study aims to compare the effectiveness of two different techniques of obturator nerve block during TURBT. Methods: A prospective, observational study was conducted in the Department of Anaesthesia, Analgesia, Palliative and Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh, between September 2018 and August 2019 to evaluate the effectiveness of ultrasound guided ONB versus cystoscopy guided ONB in TURBT operation. A total of 60 selected patients were randomly allocated into two groups: ultrasound guided ONB (group A) and cystoscopy guided ONB (group B) i.e. 30 in each group. Then onset of anesthesia (nerve block), tumour removal and patient outcome were assessed at different point during and after surgery. Results: Mean age of the patients was 54.7±8.53 years. In total, 34(57%) cases were male and 26(43%) were female. Male to female ratio was 1.3:1. In group A, 19(63.3%) patients had ASA II status and 11(36.7%) had ASA III status, while in group B, the numbers were 18(60%) and 12(40%) respectively. There was no significant difference in demographics and ASA status between two groups (P&gt;0.05). Average onset of obturator nerve block was faster in group A (8.17±1.4 min) than group B (11.3±2.68 min), (P&lt;0.001). Total resectability of tumours were achieved in 28(93.3%) in group A and 23(76.6%) in group B during operation (P&lt;0.001), while 2(22.22%) and 7(77.77%) tumours had incomplete removal respectively (P&lt;0.05). Among complications, adductor jerks were evident in 2(6.7%) and 7(23.3%), bladder perforation in 1(3.3%) and 4(13.3%), and bleeding in 1(3.3%) and 3(10.0%) cases in group A and group B respectively. The differences were statistically significant ((P&lt;0.05). Conclusion: Although both techniques are safe and easy to perform, ultrasound guided ONB results in faster onset of block and better resectability of tumour with less complication over cystoscopy guided ONB. J Dhaka Med Coll. 2021; 30(2) : 208-213

Comparison of the efficacy of five different objective methods to evaluate the success of infraclavicular block; which one of them is a reliable and early indicator?

Traditional methods that evaluate the success of peripheral nerve block have been replaced by methods that allow objective evaluations over time. Multiple objective techniques for peripheral nerve block have been discussed in the literature. This study aims to investigate whether perfusion index (PI), non-invasive tissue hemoglobin monitoring (SpHb), tissue oxygen saturation (StO2), tissue hemoglobin index (THI), and body temperature are reliable and objective methods to evaluate the adequacy of infracla-vicular blockage. Ultrasound-guided infraclavicular block in 100 patients undergoing forearm surgery. PI, SpHb, StO2, THI, and body tem-perature measurements was recorded 5 min before the block procedure, right after the procedure, and until the 25th min after the procedure at 5-min intervals. These values were compared between the blocked limbs and non-blocked limbs while being statistically compared between the successful and failed block groups. Although there were significant differences between the groups of blocked extremity and non-blocked extremity in terms of StO2, THI, PI, and body temperature, there was no significant difference between these groups in terms of SpHb. Moreover, a sig-nificant difference was detected between the groups of successful block and failed block in terms of StO2, PI and body temperature, while there was no significant difference between these groups in terms of THI and SpHb. StO2, PI, and body temperature measurements are the simple, objective, and non-invasive techniques to be used to evaluate success of block procedures. According to the receiver operating characteristic analysis, StO2 is the specific parameter with the highest sensitivity among these parameters.

Effectiveness of thaumaturgic distraction in alleviation of anxiety in 4-6-year-old children during inferior alveolar nerve block administration: a randomized controlled trial.

Dental anxiety is a matter of serious concern to pediatric dentists as it may impede the efficient delivery of dental care. If not adequately resolved, a persistent negative response pattern may emerge. Thaumaturgy, commonly known as magic trick, has become popular recently. It is a tool that distracts and relaxes the child by using magic trick while the dentist performs necessary treatment. Hence, the aim of this study was to evaluate the effectiveness of Thaumaturgic aid in alleviation of anxiety in 4-6 - year-old children during administration of local anesthesia using the inferior alveolar nerve block (IANB) technique. Thirty children aged between 4-6 years with dental anxiety requiring IANB were included in this study. Patients were divided equally into two groups: Group I, thaumaturgic aid group and Group II, conventional non-pharmacological group using randomization. Anxiety was measured before and after using the intervention with Raghavendra Madhuri Sujata-Pictorial scale (RMS-PS), Venham's anxiety rating scale, and pulse rate. All the data were tabulated and compared using statistical analysis. Children in thaumaturgy group (Group- I) exhibited significantly lower anxiety during IANB in comparison with children in the conventional group (Group- II) and the difference was statistically significant. Magic tricks are effective in reducing anxiety among young children during IANB; Moreover, it expands the arsenal of behavior guidance techniques for treatment of children with anxiety and plays an important role in shaping the behavior of a child in pediatric dentistry.

Postoperative Analgesia in Ultrasound-Guided 3-in-1 Block versus Fascia Illiaca Compartment Block in Adult Patients Undergoing Lower Limb Orthopaedic Surgeries under General Anaesthesia: A Randomised Clinical Study

Introduction: Three-in-one block and Fascia Illiaca Compartment Block (FICB) are two peripheral nerve block techniques that target the femoral nerve, obturator nerve and lateral femoral cutaneous nerve in a single injection. Both nerve blocks are used to provide anaesthesia and analgesia to the lower limb for various surgical procedures. The use of ultrasonography in peripheral nerve blocks helps to visualise the nerve, needle, and the distribution of the drug in real-time. It, thus, shortens the time of onset of sensory block, decreases performance time, and lowers the required drug doses, and finally increases chances of a favourable outcome from the nerve block. Aim: To compare the postoperative analgesic efficiency of ultrasound-guided 3-in-1 block with FICB in patients undergoing lower limb orthopaedic surgeries under General Anaesthesia (GA). Materials and Methods: A randomised clinical study was conducted at a tertiary care hospital. One hundred and fifty patients were randomly allocated to two groups, 3-in-1 block group or FICB. Both groups received the respective blocks after surgery before extubation. Postoperatively, Visual Analog Scale (VAS) scores were evaluated hourly for first 6 hours and 2 hourly thereafter until rescue analgesia was instituted. Time period from giving the block to giving rescue analgesia was noted as duration of analgesia. Injection diclofenac 1.5 mg/kg Intravenous (IV) was given when VAS value reached ≥4. Results: On analysis of 150 patients, divided into 3-in-1 block group (N=75) and FICB Group(N=75); mean age: 53.29±8.69 years; the VAS scores at 2 to 18 hours, 20 hours, and 22 hours after performing the blocks were significantly less in the 3-in-1 block group compared to FICB group. Also, the mean time (hours) for first rescue analgesia in FICB group (3.49±0.53) was earlier compared with 3-in-1 block group (7.35±0.51). Conclusion: A 3-in-1 block provides effective and prolonged postoperative analgesia in comparison to FICB.

Recent advancements in regional anaesthesia.

Patient safety, improved quality of care, and better patient satisfaction and functional outcomes are currently the topmost priorities in regional anaesthesia (RA) and all advancements in RA move in this direction. Ultrasonography-guided central neuraxial and peripheral nerve blocks, intracluster and intratruncal injections, fascial plane blocks, diaphragm-sparing blocks, use of continuous nerve block techniques, and continuous local anaesthetic wound infiltration catheters are now topics of popular clinical interest. The safety and efficacy of nerve blocks can be improved with the help of injection pressure monitoring and the incorporation of advanced technology in the ultrasound machine and needles. Novel procedure-specific and motor-sparing nerve blocks have come up. The anaesthesiologist of the current era, with a good understanding of the sonoanatomy of the target area and the microarchitecture of nerves, along with the backup of advanced technology, can be very successful in performing RA techniques. RA is rapidly evolving and revolutionising the practice of anaesthesia.

Comparative efficacy of sciatic obturator and femoral nerve block technique with that of adductor canal block in patients undergoing elective knee surgeries: a prospective, randomized, double-blind study

Comparative efficacy of sciatic obturator and femoral nerve block technique with that of adductor canal block in patients undergoing elective knee surgeries: a prospective, randomized, double-blind study

The performance of inferior alveolar nerve block technique among undergraduate students.

This study aimed at evaluating the ability to feel bone touch, positive aspirations, and frequency of the success rate during the direct inferior alveolar nerve block (IANB) among dental students. This prospective cross-sectional study involved 203 cases of IANB injections for patients requiring extraction of mandibular posterior teeth who visited student dental clinics at Ajman University, Fujairah Campus. Students' performance of direct IANB including ability to perceive bone touch, frequency of positive aspirations, and success rate were reported. Students reported feeling bone contact in 148 (72.9%), 43 (21.2%), and 12 (5.9%) of the first, second, and third attempts during the IANB, respectively. Positive aspiration was found in 46 (22.7%) of the injections. The success was in 195 (96.1%) of the total injections. Spearman's correlation coefficient indicated that there was no significant correlation between the success rate and the result of aspiration (rho=.054, p= .440). Additionally, there was no correlation between attempts to touch the bone and the outcome of the aspiration (rho=-.091, p= .198) or success rate (rho=-.083, p= .240). There is a relatively high success rate of direct IANB technique among dental students. This confirms the inclusion of this technique in the curriculum. Furthermore, the high rate of positive aspiration reflects the awareness and competency of dental students with the aspiration technique. In turn, this will reduce the failure of anaesthesia and the subsequent systemic complications.

Safety and accuracy of blind vs. ultrasound-guided dorsal retrobulbar nerve blocks in horses-A cadaveric study.

There is limited knowledge regarding the safety and accuracy of ultrasound-guided retrobulbar nerve blocks in horses. The aim of this study was to compare these parameters between blind and ultrasound-guided injection techniques for the dorsal retrobulbar nerve block in horses. Equine cadaver heads were used to inject the retrobulbar space with contrast medium (CM). Injections were performed either blindly based on anatomic landmarks (blind group, n=44) or under ultrasonographic guidance (US-group, n=44), equally divided between an experienced and unexperienced operator. Needle position and distribution of CM were assessed with computed tomography imaging and evaluated by a board-certified veterinary diagnostic imager blinded to the technique. Safety and accuracy of both techniques were compared. Ocular penetration was observed in two cases (n=2/44) in the blind group but not in the US group (n=0/44). No intrathecal, intraneural, or intravascular injections were seen in either group. Safety was significantly improved in the US group (p=.026). There was no statistically significant difference between the groups regarding the accuracy of the injection. Excellent accuracy was achieved more often with the ultrasound-guided technique (n=11/22) than with the blind technique (n=7/22) when performed by the unexperienced operator, but this difference was not statistically significant. To prevent globe-threatening complications and improve the safety of the injection, we recommend using the ultrasound-guided injection technique for the dorsal retrobulbar nerve block.

Comparison of two techniques of airway anaesthesia for awake fibreoptic nasotracheal intubation in patients with anticipated difficult airway

Introduction: The success of awake fibreoptic assisted intubation often depends on the adequacy of anaesthesia of the airway and patient comfort for the procedure. Aim: To compare the standard technique (nerve block) of airway anaesthesia with simple aspiration of lignocaine. Methods: Thirty patients in whom difficult airway was anticipated were randomly allocated into either Group A (Aspiration) and Group B (Nerve block). In Group A, 0.2 mL/kg of 1.5% lignocaine was trickled on to the dorsum of the tongue while the patient was encouraged to breathe through the mouth. In Group B, superior laryngeal nerve block and intratracheal injection of lignocaine was used. Fibreoptic bronchoscopy was then carried out by a consultant anaesthesiologist, who was blinded to the local anaesthetic technique used. The patient responses to instrumentation of pharynx, glottis and trachea, and tolerance of the endotracheal tube were noted. Results: Two cases were excluded from the study because of bleeding resulting in subsequent loss of visualisation of glottis through bronchoscope. There was no statistical or clinical difference in the patient responses between the two groups (P &gt; 0.05) due to fibreoptic bronchoscope in the pharynx, larynx and endotracheal tube in the trachea or with regard to the use of rescue medications. Conclusions: Aspiration of 1.5% lignocaine (0.2 mL/kg) provides clinically comparable conditions for intubation as the nerve block technique for awake fibreoptic nasotracheal intubation in patients with anticipated difficult airway.

Hepatic Hilar Nerve Block for Adjunctive Analgesia during Percutaneous Thermal Ablation of Hepatic Tumors: A Retrospective Analysis

PurposeTo determine whether hepatic hilar nerve block techniques reduce analgesic and sedation requirements during percutaneous image-guided thermal ablation of hepatic tumors. Materials and MethodsA single-center retrospective cohort analysis was performed of 177 patients (median age, 67 years; range, 33–86 years) who underwent percutaneous image-guided thermal ablation of liver tumors. All patients were treated utilizing local anesthetic and moderate sedation between November 2018 and November 2021 at a tertiary level hospital, with or without the administration of a hepatic hilar nerve block. Univariable and multivariable linear regression analyses were performed to determine the relationship between the administration of the hilar nerve block and fentanyl and midazolam dosages. ResultsA total of 114 (64%) patients received a hilar nerve block in addition to procedural sedation, and 63 (36%) patients received procedural sedation alone. There were no significant differences in the baseline demographic and tumor characteristics between the cohorts. The procedure duration was longer in the hilar block cohort than in the unblocked cohort (median, 95 vs 82 minutes; P = .0012). The technical success rate (98% in both the cohorts, P = .93) and adverse event rate (11% vs 3%, P = .14) were not significantly different between the cohorts. After adjusting for patient and tumor characteristics, ablation modality, and procedure and ablation durations, hilar nerve blocks were associated with lower fentanyl (−18.4%, P = .0045) and midazolam (−22.7%, P = .0007) dosages. ConclusionsHepatic hilar nerve blocks significantly decrease the fentanyl and midazolam requirements during thermal ablation of hepatic tumors, without a significant change in the technical success or adverse event rates.

8954 Abdominal Wall Nerve Blocks

<h3>Study Objective</h3> To demonstrate the nerve block techniques for the ilioinguinal, iliohypogastric, lateral femoral cutaneous, and the genital branch of the genitofemoral nerves. <h3>Design</h3> Procedural video. <h3>Setting</h3> Operating room at an academic medical center. <h3>Patients or Participants</h3> Patients with chronic abdominal pain. <h3>Interventions</h3> This video demonstrates how to perform nerve blocks to the ilioinguinal, iliohypogastric, lateral femoral cutaneous, and genital branch of the genitofemoral nerves. It also highlights the techniques of these nerve blocks and includes general management and follow-up principles for these patients. <h3>Measurements and Main Results</h3> Patients' individual responses to nerve blocks are assessed on a pain scale of 0-10. They are measured prior to and after nerve blocks to gauge response. <h3>Conclusion</h3> Determining the source of chronic abdominal and pelvic pain can be difficult for gynecologists. Nerve blocks can be an effective strategy to help evaluate and possibly treat abdominal wall pain. These blocks can delineate whether pain is originating from the abdominal wall or from another source. Nerve blocks can also potentially be therapeutic in instances of nerve entrapment, muscle spasms, neuralgia, or myofascial pain. These instructional videos on administering abdominal nerve blocks can help gynecologists provide another potential source of therapy for their patients.

Pelvic Nerve Blocks

<h3>Study Objective</h3> To demonstrate nerve block techniques for the obturator nerve, pudendal nerve, and uterine nerves (paracervical block). <h3>Design</h3> Procedural video. <h3>Setting</h3> Academic medical center. <h3>Patients or Participants</h3> Patients with chronic pelvic pain. <h3>Interventions</h3> This video demonstrates how to perform obturator, pudendal, and paracervical nerve blocks. This video highlights the techniques of these pelvic floor nerve blocks and includes general management and follow-up principles for these patients. <h3>Measurements and Main Results</h3> Pain scores, on a scale of 0-10, are measured prior to and after nerve blocks to gauge response. <h3>Conclusion</h3> Determining the source of chronic pelvic pain can be difficult for gynecologists. Nerve blocks can be an effective strategy to help evaluate and possibly treat pelvic pain. Pelvic floor nerve blocks can delineate whether or not pain is originating from the pelvic floor, uterus, or other source. Nerve blocks can also potentially be therapeutic in instances of nerve entrapment, muscle spasms, neuralgia, or myofascial pain. These instructional videos on administering pelvic floor nerve blocks can help gynecologists provide an additional source of therapy for their patients.

Prospective Evaluation of Suprazygomatic Maxillary Nerve Block in Cleft Palate Repair

INTRODUCTION: Nerve block techniques anecdotally provide superior analgesia while avoiding complications of opioids after cleft palate repair. We performed a prospective, randomized, controlled trial to compare the efficacy of a suprazygomatic maxillary nerve block (SMB) vs local anesthesia (LA) in decreasing postoperative opioid consumption. METHODS: Patients undergoing primary palatoplasty between March and November 2021 were randomized to receive either (1) SMB with 0.15 ml/kg of 0.2% ropivacaine per side and palatal injection of saline with 1:400,000 epinephrine or (2) LA using 2 ml/kg of 0.125% bupivacaine with 1:400,000 epinephrine. Paired t-tests compared pain scores (Face, Legs, Activity, Crying and Consolability [FLACC]), opioid consumption (morphine milligram equivalents [MME]), oral intake for the first 24 hours postoperatively (POD1), and length of stay (LOS; Table). Table. - A Comparison of Postoperative Outcomes Between the Nerve Block and Local Anesthesia Outcome parameter Local SMB p Value FLACC Scores POD1 2.60 1.64 0.04* Intraoperative MME 2.27 1.99 0.29 MME on POD1 2.21 1.55 0.24 Time to opioid administration (min.) 122.71 151.43 0.32 Time to oral intake (min.) 114.14 310.28 0.03* Total oral intake on POD1 (ml) 567.85 442.14 0.18 LOS (hrs.) 29 28.28 0.35 RESULTS: Fifteen patients met all study endpoints (n = 7 SMB; n = 8 LA). Mean ages at the time of repair were 11.96 (SMB) and 11.17 (LA) months. SMB patients demonstrated lower mean FLACC (1.64 SMB vs 2.60 LA; p = 0.04), yet no significant difference in MME (1.55 SMB vs 2.21 LA; p = 0.24) or in time to opioid administration postoperatively (151.43 min. SMB vs 122.71 min. LA; p = 0.32). SMB patients displayed longer time to oral intake postoperatively (310.3 min. SMB vs 114.1 min. LA; p = 0.03), but no difference in total intake (p = 0.18). CONCLUSION: SMB at the time of cleft palate repair may decrease postoperative pain scores, yet worsen the immediate ability to feed after surgery. Using pain scores to guide and standardize narcotic administration may lead to lower opioid consumption after SMB.

Digital Nerve Blocks: A Comprehensive Review of Techniques

BackgroundFinger and toe injuries are a common reason for presentation to the emergency department. In order to properly care for these injuries, it is valuable for emergency medicine clinicians to be aware of the different approaches to anesthetize the digit. MethodsWe searched the literature using PubMed to determine the different techniques and supporting data for digital nerve blockades. DiscussionThe primary digital nerve block techniques include the dorsal web space block, transthecal block, volar subcutaneous block, and the circumferential (three-sided and four-sided) ring block. Success rates range from 60% to 100%. There are unique advantages and limitations of each block that are important to consider. ConclusionsThere are a number of options at the disposal of the emergency medicine clinician for anesthesia of the finger and toe. This article summarizes the key techniques, variations on these techniques, advantages, and disadvantages for each approach.

CBCT appraisal of anatomical landmarks used in Vazirani-Akinosi nerve block technique.

The aim of this cross-sectional study was to assess the proximity of maxillary second molar (MSM) and maxillary tuberosity (MT) to mandibular foramen (MF) to perform successful Vazirani-Akinosi nerve block (VANB) technique. Cone beam computed tomography (CBCT) images of 2613 sides of the jaw were selected for the study. The vertical distance from MSM to the MF and the vertical distance from MT to the MF and from MT to the posterior border of the ramus (PR) were measured and compared between males and females using independent samples t test. The mean values of all vertical measurements were higher in males than in females, and the difference was statistically significant in case of the vertical distance from MSM to the MF and the vertical distance from MT to the PR (P < .05). This study showed the gender differences in MSM and MT measurements used to locate MF in VANB technique. This fundamental knowledge should be considered in performing VANB technique.

A randomized, controlled simulation study comparing single and double operator ultrasound-guided regional nerve block techniques using a gelatine-based home-made phantom.

Background:The aim of this study was to compare anesthesiology residents’ acquisition of gripping and needling skills in either single-or double-operator ultrasound-guided nerve block using a hand-made phantom.Design:Prospective, randomized controlled study.Methods:After a tutorial session, 47 ultrasound-novice residents performed needling with double and single operator (Jedi, Bedforth, On-lock) grip techniques in each of the 3 interventional task sessions.Results:The time to perform the correct grip and needling decreased significantly between sessions for each technique (P < .001). While the double operator tasks required a shorter time than the single operator tasks in all 3 sessions (P < .001), there was no significant difference between the single-operator techniques. The number of needling attempts was similar between techniques and sessions. Participants rated the workload higher for the single-operator techniques on the National Aeronautics and Space Administration Task Load Index.Conclusion:Hands-on training of phantom models may be beneficial for the acquisition of single-operator grip skills.