Ultrasound-guided Axillary Brachial Plexus Research Articles

Comparison between Ultrasound Guided Axillary Brachial plexus Block versus Intravenous Regional Block in Forearm Surgeries

Comparison between Ultrasound Guided Axillary Brachial plexus Block versus Intravenous Regional Block in Forearm Surgeries

A Randomised Controlled Study of Two Different Doses of Bupivacaine in Ultrasound Guided Axillary Brachial Plexus Block

Introduction: The use of Ultrasound (USG) for needle precision aids in reduction of local anaesthetic volume needed for peripheral nerve blockade. Conventional dosages of 30 to 40 mL of local anaesthetic mixture have been used in peripheral nerve blockades but using a lesser volume will reduce the incidence of local anaesthesia associated systemic toxicity. Aim: To assess the efficacy of two different doses 20 mL and 25 mL of Bupivacaine in USG guided axillary plexus block. Materials and Methods: Sixty patients requiring forearm and hand surgeries were randomised into two groups. Group A received low volume (20 mL of 0.375% bupivacaine) and group B received intermediate volume (25 mL of 0.375% bupivacaine). The quality of anaesthesia in regards to sensory and motor blockade, duration of analgesia, haemodynamic variability and complications were evaluated. Successful block was defined by Vester Anderson’s criteria. Duration of analgesia was measured using Visual Analogue Scale (VAS). Statistical comparison of all continuous variables were assessed utilising Student’s t-test and Mann-Whitney U-test as applicable. Results: No significant difference in onset times were observed as far as sensory and motor blockade was concerned between the two groups A and B with p-values of 0.69 and 0.40, respectively. Group B had significantly longer duration of block in comparison with Group A (p<0.001). Two patients in group A and one patient in Group B required supplemental analgesia with fentanyl boluses. Haemodynamics were stable and no complications were seen in both the groups. Conclusion: Lower volume of Bupivacaine is convincingly prudent for regional blockade under USG guidance than suggested in literature.

A study to compare the haemodynamic stability and side effects when using 0.5 percent levobupivacaine vs combination of 0.5 percent levobupivacaine and hyaluronidase, in ultrasound guided axillary brachial plexus block for forearm and hand surgeries

Background: One key component of enhanced recovery protocols is standardized analgesic and anesthetic regimens. Peripheral nerve blocks in particular help in enhanced recovery of the patient by the possibility of early mobilization of the patient. Local Anesthetics are drugs that prevent conduction of electrical impulses on the membranes of nerve and muscle. Adjutants are pharmacological drugs that when co- administered with local anaesthetic agents may improve speed of onset as well as the quality and duration of analgesia. Hyaluronidase drug works as a spreading factor by increasing tissue membrane permeability and reducing the viscosity. Objective: To find if there are any hemodynamic problems or any side effects when Levobupivacaine is used alone compared to Levobupivacaine when used with Hyaluronidase. Materials and Methods: After institutional ethical committee clearance 60 ASA PS class 1 and 2 adult patients in age group of 18 to 60 years who underwent elective upper limb surgeries in Sridevi Institute of Medical Sciences, Tumkur from October 2017 to October 2019 were included. Any patient with history of bleeding disorders, documented neuromuscular disorders, known allergy to Local anesthetics drugs, Psychiatric patients and if on anticoagulants were excluded from the study. Patients were alternately assigned to two groups Group A and Group B each containing 30 patients. Patients undergoing Ultrasound guided Axillary Brachial plexus block with. Group A: 20 ml of 0.5% Levobupivacaine and Hyaluronidase 300 Units (15U/ml of local anesthetic). Group B: 20 ml of 0.5% Levobupivacaine. The patients were given Ultrasound guided Axillary brachial plexus block. Hemodynamic parameters like pulse rate, non-invasive blood pressure, oxygen saturation was monitored. Mean arterial blood pressure (MAP) and pulse rate (PR), oxygen saturation was recorded before application of the block as well as immediately after block & 3 min intervals until the end of the operation. Any drop-in blood pressure more than 20% from the baseline signifies hypotension and was managed with Inj ephedrine 6 mg. Any decrease in pulse rate of less than 60 beats /min was managed with Inj. atropine 0.6mg. Any other complication other than this was noted. Results: Mean pulse rate was similar in both groups with Group A 81.87 and Group B 81.43. Mean arterial pressure between 2 groups was also similar MAP of Group A 105.3 and Group B 105.07. Conclusion: No significant hemodynamic changes were noted between both the groups. Hyaluronidase used as adjuvants along with local anaesthetics to improve the quality of block has no adverse effect on the hemodynamics, unlike other agents (adrenaline, dexmeditomidine, clonidine). It has a good safety profile.

A study of comparison of the efficacy of 0.5 percent Levobupivacaine with a combination of 0.5 percent Levobupivacaine and hyaluronidase, in ultrasound guided axillary brachial plexus block for forearm and hand surgeries

Background: Axillary block is a regional anesthesia for surgeries at and below the elbow. Complications associated with peripheral blocks using blind approaches are addressed with advent of ultrasound guidance. Hyaluronidase drug works as a spreading factor. Combination of ultrasound guidance and hyaluronidase in addition to local anesthetics in peripheral blocks will increase efficacy and reduce complications. Objective: The objective of the study is to compare the efficacy of 0.5% Levobupivacaine with a combination of 0.5% Levobupivacaine and hyaluronidase in USG guided axillary brachial plexus block for forearm and hand surgeries with respect to: Onset of sensory and motor block, duration of sensory block and time to rescue analgesia. Materials and Methods: After institutional ethical committee clearance 60 ASA PS class 1 and 2 adult patients in age group of 18 to 60 year who underwent elective upper limb surgeries in sridevi institute of medical sciences, tumkur from October 2017 to dec 2019 were included. Any patient with history of bleeding disorders, documented neuromuscular disorders, known allergy to Local anesthetics drugs, Psychiatric patients and if on anticoagulants were excluded from the study. Patients were alternately assigned to two groups Group A and Group B each containing 30 patients Patients undergoing Ultrasound guided Axillary Brachial plexus block with. GROUP A – 20 ml of 0.5% Levobupivacaine and Hyaluronidase 300 Units (15U/ml of local anesthetic) GROUP B – 20 ml of 0.5% Levobupivacaine. The patients were given Ultrasound guided Axillary brachial plexus block. onset of sensory blockade, onset of motor blockade, sensory block duration and time to rescue analgesia were compared. Results: The mean onset of sensory block in group A was 10.10±0.9 minutes and group B was 13.33±0.9 minutes. The mean onset of motor block in group A was 11.73±1.66 minutes and in group B was 14.23±1.45 minutes. The mean duration of sensory block in group A was 7.8±1.0 hours and in group B was 10.8±2.0 hours the mean time to rescue analgesia in group A was 9.9±1.3 hours and in group B was 12.2±2.0hours. Conclusion: In ultrasound guided axillary brachial plexus block using 0.5% levobupivacaine, addition hyaluronidase reduces onset of sensory and motor block time therefore shortens the total anaesthetic time before the operation. It also reduces the duration of post operative sensory block time and time to requirement of rescue analgesia.

Bilateral variant locations of the musculocutaneous nerve during ultrasound-guided bilateral axillary brachial plexus block -A case report-

Bilateral variant locations of the musculocutaneous nerve during ultrasound-guided bilateral axillary brachial plexus block -A case report-

A Study on Efficacy of Clonidine and Dexmedetomidineas Adjuvants with 0.5% Levobupivacaine in Ultrasound Guided Axillary Brachial Plexus Block for Upper Limb Orthopedic Surgeries

A Study on Efficacy of Clonidine and Dexmedetomidineas Adjuvants with 0.5% Levobupivacaine in Ultrasound Guided Axillary Brachial Plexus Block for Upper Limb Orthopedic Surgeries

Ultrasound Guided Axillary Brachial Plexus Catheter in a Patient with Severe Hemophilia

We report a case of uncomplicated axillary catheter placed under ultrasound guidance in a patient with severe hemophilia. This catheter, inserted when the patient was fully substituted with factor VIII, was indicated for postoperative physiotherapy after elbow arthrolysis. Ultrasound control showed no local bleeding. Withdrawal was uneventful. Efficient analgesia allowed intensive elbow mobilization.

Axillary Block as the Sole Anesthetic for Peripherally Inserted Central Catheter Placement in an Infant with Goldenhar Syndrome

The use of peripheral nerve block as the sole anesthetic in infants is not very common. Studies have demonstrated that ultrasound guided (USG) peripheral nerve block is associated with higher overall success rate when compared with nerve stimulation (Rubin et al., 2009, and Gelfand et al., 2011). Described below is a medically complex infant who had an USG axillary brachial plexus block for peripherally inserted central catheter (PICC) placement.

391. Ultrasound Guided Axillary Brachial Plexus Blocks in a Specialist Plastic Surgery Unit Accustomed to Transarterial Brachial Plexus Blocks

391. Ultrasound Guided Axillary Brachial Plexus Blocks in a Specialist Plastic Surgery Unit Accustomed to Transarterial Brachial Plexus Blocks

391: Ultrasound Guided Axillary Brachial Plexus Blocks in a Specialist Plastic Surgery Unit Accustomed to Transarterial Brachial Plexus Blocks

391: Ultrasound Guided Axillary Brachial Plexus Blocks in a Specialist Plastic Surgery Unit Accustomed to Transarterial Brachial Plexus Blocks

Ultrasound Guided Axillary Brachial Plexus Blocks in a Specialist Plastic Surgery Unit Accustomed to Transarterial Brachial Plexus Blocks

Ultrasound Guided Axillary Brachial Plexus Blocks in a Specialist Plastic Surgery Unit Accustomed to Transarterial Brachial Plexus Blocks