Ultrasound-guided Brachial Plexus Block Research Articles

Sonographic assessment of hemi-diaphragmatic palsy post brachial plexus blocks

Background and Aim: Brachial plexus blocks (BPB) are indispensable in providing surgical anaesthesia and postoperative analgesia. Although Hemi-diaphragmatic palsy (HDP) after BPB is clinically insignificant in the majority, it can cause significant physiological impairment in patients with reduced pulmonary function. Sonographic assessment of diaphragmatic function using the ABCDE approach provides accurate and quantitative information on HDP. This can be performed bedside before and after administration of the nerve block to quantify HDP. This was a prospective observational study comparing ultrasound-guided diaphragmatic thickness in two approaches of ultrasound-guided BPB. Methodology: Eighty participants receiving eitherinterscalene/supraclavicular BPB were included in this observational study. Baseline vitals, NRS score for pain and ultrasound-guided diaphragm thickness at inspiration and expiration using the ABCDE approach were noted. After 20 minutes of BPB administration, the diaphragm thickness was remeasured. Results: Eighty participants completed the study, forty from either group. Average volume of the total local anaesthetic drug mixture used was noted to be 30ml. The diaphragmatic thickness ratio in the supraclavicular group was found to decrease by 2.34% as compared to 2.39% in the interscalene group. (p-value 0.256 baseline values,0.292 for post block values) The thickness fraction was found to decrease by 9.21% in Group A as compared to 9.04% in Group B (P value 0.248 baseline values and 0.292 post-block values). There was no statistically significant difference between the diaphragm thickness in both the group'spre- and post-block, irrespective of the approach used. Conclusion: The ABCDE approach to measure diaphragm thickness can be used as a simple bedside modality to quantify the amount of HDP occurring after ultrasound-guided BPB. It is easy to learn & a non-invasive modality which can be used to improve patient safety during BPB Bangladesh Journal of Medical Science Vol.23 (Special Issue) 2024 p.S101-S106

Convolutional neural network for brachial plexus segmentation at the interscalene level

BackgroundRegional anesthesia with ultrasound-guided brachial plexus block is widely used for patients undergoing shoulder and upper limb surgery, but needle misplacement can result in complications. The purpose of this study was to develop and validate a convolutional neural network (CNN) model for segmentation of the brachial plexus at the interscalene level.MethodsThis prospective study included patients who underwent ultrasound-guided brachial plexus block in the Anesthesiology Department of Beijing Jishuitan Hospital between October 2019 and June 2022. A Unet semantic segmentation model was developed to train the CNN to identify the brachial plexus features in the ultrasound images. The degree of overlap between the predicted segmentation and ground truth segmentation (manually drawn by experienced clinicians) was evaluated by calculation of the Dice index and Jaccard index.ResultsThe final analysis included 502 images from 127 patients aged 41 ± 14 years-old (72 men, 56.7%). The mean Dice index was 0.748 ± 0.190, which was extremely close to the threshold level of 0.75 for good overlap between the predicted and ground truth segregations. The Jaccard index was 0.630 ± 0.213, which exceeded the threshold value of 0.5 for a good overlap.ConclusionThe CNN performed well at segregating the brachial plexus at the interscalene level. Further development could allow the CNN to be used to facilitate real-time identification of the brachial plexus during interscalene block administration.Clinical trial registrationThe trial was registered prior to patient enrollment at the Chinese Clinical Trial Registry (ChiCTR2200055591), the site url is https://www.chictr.org.cn/. The date of trial registration and patient enrollment is 14/01/2022.

Ultrasound-guided Brachial Plexus Block as a Sole Anaesthetic Technique in a Child for Fixation of Humerus Fracture: A Case Report

Managing supracondylar fractures provides distinct problems in the complex setting of paediatric trauma. A 36-month-old male child was admitted with accidental injury and supracondylar fracture of left humerus. There were no other injuries. The child was planned open reduction and internal fixation in the right lateral position. The plan was to administer nerve block. To satisfactorily transfer the baby, the authors administered 5 mg of oral diazepam to the mother after explanation. The patient was smoothly transferred inside with syrup promethazine 5 mL. After securing an intravenous access, and an intravenous pethidine of 10 mg, he was administered ultrasound guided brachial plexus block with a supraclavicular approach with 5 mL of 0.5% bupivacaine. The pain subsided and the patient slept well. The surgery and the postoperative period were uneventful. The authors concluded that sedating the mother prior will help in separation and nerve blocks can be administered in children in precise sites with the help of ultrasound but without supplemental general anaesthesia. This report is the first case report to do without the use of any intravenous anaesthetic drugs.

Brachial plexus block using only 1% lidocaine to reduce pain during the endovascular treatment of dysfunctional arteriovenous access.

Interventional endovascular treatments of dysfunctional arteriovenous (AV) access for hemodialysis can cause pain and discomfort to the patients. Ultrasound-guided brachial plexus block (BPB) is an alternative regional anesthesia method, but conventional BPB using ropivacaine or bupivacaine may cause long-lasting motor power loss, significantly reducing patient satisfaction. This study aimed to introduce BPB using only 1% lidocaine, which induces sensory loss while minimizing motor block, and evaluate the efficacy and safety of this procedure. This retrospective study was conducted on 277 consecutive patients with dysfunctional AV access requiring percutaneous transluminal angioplasty (PTA). Of these, 174 patients underwent the BPB procedure using 1% lidocaine. Time data were recorded, and the motor strength grade (MRC scale, grade 0-5) was evaluated. Numeric rating pain score (NRPS, grade 0-10) was asked during every PTA, and overall NRPS and satisfaction scores (scale 1-3) were asked after the procedure was completed. Of the 174 patients who received BPB, the success rate was 100%, and there were no significant complications related to BPB. The MRC scale measured at the time when the complete sensory loss was achieved was 1.99 ± 0.63, and that at the point of sensory recovery when the block effect expired was 3.93 ± 0.62, indicating a good grade of motor strength. The average NRPS during PTA in the BPB group was significantly lower than that of the control group without BPB (1.04 ± 2.04vs 6.30 ± 2.71, p < 0.001). The overall satisfaction score was significantly higher in the BPB group than in the control group (2.79 ± 0.50vs 2.00 ± 0.81, p < 0.001). BPB using only 1% lidocaine can induce a sensory block while minimizing the effect on motor function. It can be applied safely in an outpatient clinic setting with relatively higher satisfaction.

Analgesic and safety analysis of dexmedetomidine combined with ropivacaine in ultrasound-guided brachial plexus nerve block

Purpose: To investigate analgesic effect and safety of dexmedetomidine combined with ropivacaine in ultrasound-guided brachial plexus block in intercostal space.Methods: A total of 90 patients were scheduled to undergo upper limb surgery and divided into control and study groups, respectively. Patients in control group were given ropivacaine nerve block, while those in study group were given ropivacaine combined with dexmedetomidine mixture nerve block. The efficiency of sensory and motor block, secondary evaluation of block effect, visual analogue scale (VAS) scores at different postoperative moments, remedial analgesia and adverse reactions were compared between the two groups after 30 min of drug injection.Results: The success rate of sensory block was not significantly different between control group (91.11 %) and study group (93.33 %; χ2 = 0.155, p &gt; 0.05) but success rate of the motor block was significantly higher in study group (93.33 %) than in control group (71.11 %; χ2 = 7.601, p &lt; 0.05). Compared with control group, onset of sensory block and motor block were significantly shorter in study group, while the duration of sensory block and motor block was significantly longer (p &lt; 0.05). The VAS scores at 12, 24, and 48 h postoperatively were significantly lower in study group than control group (p &lt; 0.05). The number of self-administered analgesia, number of patients, dose used, and overall incidence of adverse reactions in study group were significantly lower than in control group (p &lt; 0.05).Conclusion: Dexmedetomidine and ropivacaine, when administered together, have a significant anesthetic effect during nerve block, which is safe and enhances their analgesic effect. However, the mechanism of improving analgesic effect of the combined plan, using a larger number of samples should be further investigated.

A Comparison of Distal Nerve Blocks and Brachial Plexus Blocks in Terms of Block Success, Block-related Characteristics, Time to Discharge and Patient Satisfaction.

Background: Ultrasound-guided brachial plexus blocks (BPB) are used as an anaesthetic method in hand and wrist surgeries. The radial, median and ulnar nerves can also be selectively blocked. The objective of this retrospective cohort study was to compare distal nerve blocks (DNB) and BPB in terms of block success, block-related characteristics, time to discharge and patient satisfaction. Methods: The data of patients who underwent elective hand and wrist surgery under regional anaesthetic procedures between 01.01.2022 and 01.09.2022 were analysed. Standard multimodal analgesia was performed in all groups, in addition to either ultrasound-guided BPB or DNB. Demographic characteristics, American Society of Anaesthesiology (ASA) classes, presence of additional diseases, block and volume applied, block-related data such as block performance time, onset time, initial analgesia times, perioperative additional anaesthetic or analgesic requirement, surgery times, types of surgery, discharge times and the presence of additional complaints were recorded. In addition, the anaesthesia quality score were determined using a 5-point Likert scale. Results: There was no difference between demographic data. Average surgical time was similar between the DNB and BPB groups (46.0 ± 8.92 vs. 59.95 ± 22.04 min, p < 0.05). Block onset time was significantly lower in the DNB group (26.4 ± 2.73 vs. 32.17 ± 2.94 min, p < 0.001). When patients discharged before and after 12 hours were compared, 11/22 of the patients in the DNB group and 4/23 of the patients in the BPB group were discharged in the first 12 hours (p < 0.05). Patient satisfaction scores were similar between groups (14.22 ± 0.86 vs. 13.65 ± 1.11, p > 0.05). Conclusions: In surgeries of the hand and wrist, the radial, median and ulnar nerves can be used individually or in combination as an alternative to proximal BPB. Level of Evidence: Level III (Therapeutic).

Ultrasound-Guided Brachial Plexus Block by Costoclavicular Space Approach: A Narrative Review.

In recent years, ultrasound-guided costoclavicular brachial plexus block (CCB) has gained attention as a novel approach for brachial plexus nerve block. Human anatomy studies have identified the costoclavicular space as the area between the midpoint of the clavicle and the first rib. This space accommodates the brachial plexus, axillary arteries, and veins. Its superficial and fixed position makes it a promising option for infraclavicular brachial plexus blockage, providing a safe and reliable analgesic effect. CCB combines the benefits of real-time ultrasound visualization of the nerve block needle, avoidance of peripheral blood vessels, and targeted delivery of local anesthetics to the nerve. Consequently, it significantly reduces the associated complications of other classical approaches such as interscalene brachial plexus block (ISB), supraclavicular brachial plexus block (SCB), lateral sagittal infraclavicular brachial plexus block (LS-ICB), and axillary brachial plexus block. These complications include phrenic paralysis, incomplete brachial plexus block, and pneumothorax. This narrative review examines the literature on brachial plexus block in the costoclavicular space, discussing the anatomical position, the procedure, clinical indications, choice of local anesthetic concentration and volume, and continuous nerve block of CCB. The aim is to provide a basis for future clinical practice and enhanced safety.

Neuropathies Following an Ultrasound-Guided Axillary Brachial Plexus Block.

Ultrasound-guided brachial plexus block (UGBPB) has interscalene, supraclavicular, infraclavicular, and axillary approaches. The axillary block is considered to be the safest and with fewer adverse events compared to the interscalene (eg, phrenic nerve block, spinal cord or vertebral artery puncture) and supraclavicular (eg, pneumothorax). However, with regard to postoperative neurological symptoms (PONS), it is controversial whether its incidence after an axillary block was higher than that after non-axillary approaches". In this study, we investigated whether the incidence of a neuropathy after an axillary block was higher than that after non-axillary approaches. This was a single-center, retrospective cohort study. All UGBPBs were performed under general anesthesia between January 2014 and March 2020. The outcomes included the overall incidence of PONS and neuropathies for axillary and non-axillary approaches. The etiology, symptoms, and outcomes of patients were investigated. Of the 992 patients, 143 (14%) and 849 (86%) were subjected to axillary and non-axillary approaches, respectively. Among 19 cases (19.2:1000; 95% confidence interval [CI], 18.2-20.1) of PONS, four (4.0:1000; 95% CI, 3.8-4.2) were neuropathies attributed to the UGBPB, three (21.0:1000; 95% CI, 18.1-23.8) to the axillary and one (2.8:1000; 95% CI, 2.6-3.1) to non-axillary approaches. The incidence of neuropathies after an axillary block was significantly higher than that after non-axillary approaches (P = 0.005). The incidence of neuropathies after US-guided axillary block under general anesthesia was significantly higher than that after non-axillary approaches.

Ultrasound-Guided Brachial Plexus Block with Mepivacaine in Zaraibi Goats

Ultrasound-Guided Brachial Plexus Block with Mepivacaine in Zaraibi Goats

Two Dosages of Dexamethasone (2 mg and 4 mg) as Analgesic Adjuvant to Levobupivacaine in Ultrasound-guided Brachial Plexus Block in Upper Limb SurgeryA Randomised Clinical Trial

Introduction: Perineural dexamethasone gives promising results in prolonging duration of analgesia in brachial plexus block. Doses between 1 to 10 mg have been used but the optimum dose is not yet settled. Aim: To compare the analgesic efficacy of two low doses of dexamethasone in Ultrasonography (USG)-guided brachial plexus block for planned upper limb surgery. Materials and Methods: A double-blind randomised clinical trial was conducted with 126 adult patients of either sex, randomised in equal numbers to 2 mg and 4 mg dexamethasone groups, the steroid being administered in conjunction with 0.5% levobupivacaine. Time to onset of sensory and motor blocks, duration of analgesia, duration of motor block, total consumption of analgesics in the first 24 hours postoperative period, haemodynamic parameters and features of neurotoxicity were compared. Tramadol 50mg intravenous was permitted as rescue analgesic. Results: No significant differences in onset of sensory and motor blocks were encountered. Duration of sensory block with 4 mg {median (Interquartile range); 1080 (900-1140) min} clearly exceeded that with 2 mg {840 (720-960) min} (p-value&lt;0.001) dexamethasone. Duration of motor block was also greater with 4 mg dexamethasone {1080 (1020-1170) versus 870 (810-990)min} (p-value&lt;0.001). Total analgesic consumption in first 24 hours was 225 (175-250) mg versus 100 (75-200) mg in 2 mg and 4 mg groups respectively (p-value&lt;0.001). No features of neurotoxicity were encountered in either group. Conclusion: Perineural dexamethasone 4 mg gives better results as analgesic adjuvant to bupivacaine compared to 2mg in brachial plexus block for upper limb surgery without increasing adverse effects.

Factors associated with prolonged duration of ultrasound-guided brachial plexus block for the upper limb fracture surgery: a cross-sectional study.

Previous studies of factors associated with prolonged duration of ultrasound-guided brachial plexus block have included multiple surgical procedures or multiple anesthetic approaches, all of which are important confounders, and there is no study based on a single method of anesthesia exploring the factors affecting the resolution of brachial plexus block during upper limb surgery, especially in Asians. This study aimed to identify the risk factors affecting the prolonged duration of US-guided brachial plexus block in American Society of Anesthesiologists (ASA) I-II grade patients to improve postoperative analgesia. This study enrolled patients scheduled to undergo surgery for upper limb fracture in Anting Hospital, Shanghai from May 2021 to September 2021. Inclusion criteria: (I) patients aged 18 years and above; (II) ASA I-II grade patients; (III) success of US-guided brachial plexus block. Based on the median duration of brachial plexus block, patients were divided into a <5-hour group and a ≥5-hour group. The factors were selected base on previous studies conclution and clinical demographic characteristics of patients. Multivariable logistic regression was used to estimate relevant influencing factors. A total of 129 patients (51.2% males; 51.01±16.54 years old) were analyzed. The duration of brachial plexus block was 2-12 hours, with a median duration of 5.09 hours. Multivariable analysis suggested that age 40-49 years [odds ratio (OR): 4.841; 95% confidence interval (CI): 1.033 to 22.695; P=0.045], 50-59 years (OR: 4.730, 95% CI: 1.149 to 19.474; P=0.031), 60 years (OR: 8.540; 95% CI: 1.605 to 45.449; P=0.012), gender (OR: 3.314; 95% CI: 1.330 to 8.257; P=0.010), alanine aminotransferase (ALT; OR: 5.817, 95% CI: 1.509 to 22.472; P=0.011), and glomerular filtration rate (GFR) <60 (OR: 22.700; 95% CI: 1.994 to 198.386; P=0.012) were the risk factors for the duration of brachial plexus block. It is advisable to use the lowest effective dose for the shortest possible time when using ropivacaine in upper limb fracture surgery patients with elevated ALT (≥40 U/L) and lower GFR (<60 mL/min) in male patients aged ≥60 years.

Application Effect of Dexmedetomidine Combined with Ropivacaine in Ultrasound-guided Brachial Plexus Block

Application Effect of Dexmedetomidine Combined with Ropivacaine in Ultrasound-guided Brachial Plexus Block

Effects of ultrasound-guided brachial plexus block in combination with sevoflurane general anesthesia via laryngeal mask on upper limb tumor and fracture surgery for children based on inflammatory stress response

Sevoflurane is used successfully for general anesthesia via laryngeal mask on upper limb tumors like osteosarcoma and Ewings sarcoma and fractures in orthopedic care centers. With the advancement in interventional radiology, many procedures are now available to support surgeons to carry out such procedures without complications. In this study, we tried to evaluate the effects of ultrasound-guided brachial plexus block in combination with sevoflurane general anesthesia via laryngeal mask for upper limb tumor (osteosarcoma in the metaphysic of long bones of upper limb and Ewing sarcoma-second most malignant tumor in children) and fracture surgery in children based on inflammatory stress response. Eighty-six children who were admitted to undergo surgery for upper limb tumor and fractures from June 2018 to November 2019 were selected and divided into control and study groups according to anesthesia methods (n= 43). The control group received only sevoflurane superficial general anesthesia via laryngeal mask, besides which the study group received ultrasound-guided brachial plexus block. The surgical, anesthetic outcomes and adverse reactions were compared. Pain was assessed by the visual analogue scale (VAS) 4 h, 8 h and 12 h after surgery. The serum levels of interleukin-1β (IL-1β), IL-10, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), epinephrine (E), norepinephrine (NE), cortisol (Cor) and insulin (Ins) were measured before surgery, on the day of surgery and 3 days after surgery, respectively. Compared with the control group, the surgical time and recovery time of the study group were shorter, the pain occurred later, the intraoperative respiration was slower, and the incidence rate of adverse reactions was significantly lower. The VAS scores of the study group were significantly lower than those of the control group 4 h, 8 h and 12 h after surgery. The IL-1β, IL-10, CRP, TNF-α, E, NE, Cor, and Ins levels of the study group were also significantly lower than those of the control group on the day of surgery and 3 days after surgery. Observations of this study suggest that sevoflurane superficial general anesthesia via laryngeal mask in combination with brachial plexus block can be used in the upper limb tumor removal and fracture surgery for children. This strategy has the advantages of short recovery time, few adverse reactions, obvious sedative and analgesic effects, and low inflammatory stress response.

Application of Propofol Target-Controlled Infusion for Optimized Hemodynamic Status in ESRD Patients Receiving Arteriovenous Access Surgery: A Randomized Controlled Trial.

Background and Objectives: End-stage renal disease (ESRD) is associated with increased anesthetic risks such as cardiovascular events resulting in higher perioperative mortality rates. This study investigated the perioperative and postoperative outcomes in ESRD patients receiving propofol target-controlled infusion with brachial plexus block during arteriovenous (AV) access surgery. Materials and Methods: We recruited fifty consecutive patients scheduled to receive AV access surgery. While all patients received general anesthesia combined with ultrasound-guided brachial plexus block, the patients were randomly assigned to one of two general anesthesia maintenance groups, with 23 receiving propofol target-controlled infusion (TCI) and 24 receiving sevoflurane inhalation. We measured perioperative mean arterial pressure (MAP), heart rate, and cardiac output and recorded postoperative pain status and adverse events in both groups. Results: ESRD patients receiving propofol TCI had significantly less reduction in blood pressure than those receiving sevoflurane inhalation (p < 0.05) during AV access surgery. Perioperative cardiac output and heart rate were similar in both groups. Both groups reported relatively low postoperative pain score and a low incidence of adverse events. Conclusions: Propofol TCI with brachial plexus block can be used as an effective anesthesia regimen for ESRD patients receiving AV access surgery. It can be used with less blood pressure fluctuation than inhalational anesthesia.

Clinical Application of Ultrasound Microscopy-Guided Pediatric Brachial Plexus Nerve Block Anesthesia.

In order to investigate the anesthetic effect and safety of the ultrasound-guided brachial plexus block in pediatric upper limb surgery, this study retrospectively analyzed the anesthetic effect of the ultrasound-guided brachial plexus block in pediatric upper limb surgery. From January 2016 to December 2017, 82 children undergoing upper limb surgery in hospital A were selected and randomly divided into two groups by the coin method, with 41 children in each group. Ultrasound-guided brachial plexus block anesthesia and conventional anatomic localization brachial plexus block anesthesia were performed. The anesthetic drug dosage of sensory block at anesthesia completion time and motor block at onset time was compared between the two groups; the one-time puncture success rate and incidence of anesthesia complications were compared between the two groups (local anesthesia poisoning, nerve injury, pneumothorax, hematoma, and phrenic nerve palsy). The results showed that the anesthesia completion time in the study group was slightly longer than that in the control group. The sensory and motor block occurred earlier in the study group than in the control group. Low doses of narcotic drugs are used. The one-time puncture success rate of the study group was higher than that of the control group. The incidence of anesthesia complications was lower than that of the control group. The one-time puncture success rate was 92.8% in the study group and 75.7% in the control group. Ultrasound-guided brachial plexus block anesthesia has a significant effect in pediatric upper limb surgery, which can improve the anesthetic effect and reduce the incidence of complications, and is worthy of clinical promotion.

Application of Hydromorphone and Ropivacaine in Ultrasound-Guided Brachial Plexus Block of Children

PurposeThis research was designed to investigate the effects of hydromorphone combined with ropivacaine anesthesia on brachial plexus block of upper limbs in children. DesignThis was a randomized prospective study. MethodsA total of 120 children with upper limb fractures were included in this study and treated wtih open reduction and internal fixation (ORIF). The children were randomized into control group and research group. All of them were given a brachial plexus block and anesthetics (control group: 0.2% ropivacaine; research group: additional 5 μg/kg hydromorphone. FindingsThe time of onset and exercise recovery of the research group increased, and the use times of analgesic drugs decreased, which were significantly different from those of the control group (all P<.05). ConclusionsHydromorphone can enhance the effectiveness of ropivacaine in blocking the brachial plexus and reduce postoperative pain and the demand for analgesics. Strong postoperative sedation can improve sleep quality and nursing satisfaction.

Brachial Plexus Nerve Trunk Recognition From Ultrasound Images: A Comparative Study of Deep Learning Models

Brachial plexus block is a common regional anesthesia method widely used in upper limb surgery. Nowadays, ultrasound-guided brachial plexus block has been extensively used in clinical anesthesia. However, accurate brachial plexus block is highly dependent on the physician&#x2019;s experience, and a physician without extensive clinical experience may cause nerve injury when performing a nerve block. With the development of artificial intelligence technology, the deep learning method can automatically identify the brachial plexus in ultrasound images and assist doctors in completing the brachial plexus block accurately and quickly. In this paper, we aim to evaluate the performance of different deep learning models in identifying brachial plexus (i.e., segmentation of brachial plexus) from ultrasonic images to explore the best models and training strategies for this task. To this end, we use a new dataset containing 340 brachial plexus ultrasound images annotated by three experienced clinicians. Among the 12 deep learning models we evaluated, U-Net achieves the best segmentation accuracy, with an intersection over union (IoU) of 68.50%. However, the number of U-Net parameters is very large, and it can only process 15 images per second. Compared to U-Net, LinkNet can process 142 images per second and achieve the second-best segmentation accuracy with an IoU of 66.27%. It achieves the balance between segmentation accuracy and processing efficiency, which has a good potential for the brachial plexus&#x2019;s real-time segmentation task.

Effects of ultrasound-guided brachial plexus block combined with laryngeal mask sevoflurane general anesthesia on inflammation and stress response in children undergoing upper limb fracture surgery.

article: Effects of ultrasound-guided brachial plexus block combined with laryngeal mask sevoflurane general anesthesia on inflammation and stress response in children undergoing upper limb fracture surgery - Minerva Pediatrics 2021 Dec 21 - Minerva Medica - Journals

Postoperative neurological complications after brachial plexus block: a retrospective study conducted at a teaching hospital.

Serious complications after ultrasound-guided regional anaesthesia can be devastating for the patient. The pathogenesis of postoperative neurological complications (PONC) is multifactorial and includes mechanical, vascular and chemical factors besides the nerve puncture itself. The primary aim of this study was to assess the incidence of PONC after brachial plexus block (BPB). This is an observational retrospective single-centre study conducted at the regional anaesthesia unit of a teaching hospital. All BPBs performed from January 2011 to November 2019 were included. The outcomes analysed were the incidence, aetiology and diagnosis of PONCs and the incidence of other postoperative complications such as local anaesthetic systemic toxicity (LAST), pneumothorax, wrong-side block, etc. The performance of trainees and experienced anaesthesiologists was compared across all the outcomes. From a total of 5340 BPBs included, 15 cases developed PONC, yielding a rate of 2.81:1000 (95% CI 1.70-4.63). Thirteen patients underwent neurophysiological exams which confirmed nine neuropathies. The rate of PONCs for supervised trainees was 1.80:1000 (95% CI 0.701-4.62), not statistically different from that of experienced anaesthesiologists (p = 0.241). Three cases were considered to present with a PONC probably related to BPB [0.562:1,00 (95% CI 0.191-1.65)]. The incidence of long-term PONCs was 1.12:1000 (95% CI 0.515-2.45). Such complications proved irreversible in 2 cases. The incidences of LAST, pneumothorax and other complications observed were 0.749:1000 (95% CI 0.291-1.92), 0.187:1000 (95% CI 0.0331-1.06) and 4.31:1000 (95% CI 2.87-6.46), respectively. This survey suggests that complications after ultrasound-guided BPB, including blocks performed by trainees, are uncommon. Clinicaltrials.gov ID: NCT04451642.

Reliability and Quality of YouTube Videos on Ultrasound-Guided Brachial Plexus Block: A Programmatical Review.

Background: Ultrasound-guided regional anesthesia has gained popularity over the last decade. This study aimed to assess whether YouTube videos sufficiently serve as an adjunctive tool for learning how to perform an ultrasound-guided brachial plexus block (BPB). Methods: All YouTube videos were classified, based on their sources, as either academic, manufacturer, educational, or individual videos. The metrics, accuracy, utility, reliability (using the Journal of American Medical Association Score benchmark criteria (JAMAS)), and educational quality (using the Global Quality Score (GQS) and Brachial Plexus Block Specific Quality Score (BSQS)) were validated. Results: Here, 175 videos were included. Academic (1.19 ± 0.62, mean ± standard deviation), manufacturer (1.17 ± 0.71), and educational videos (1.15 ± 0.76) had better JAMAS accuracy and reliability than individual videos (0.26 ± 0.67) (p < 0.001). Manufacturer (11.22 ± 1.63) and educational videos (10.33 ± 3.34) had a higher BSQS than individual videos (7.32 ± 4.20) (p < 0.001). All sources weakly addressed the equipment preparation and post-procedure questions after BSQS analysis. Conclusions: The reliability and quality of ultrasound-guided BPB videos differ depending on their source. As YouTube is a useful educational platform for learners and teachers, global societies of regional anesthesiologists should set a standard for videos.