scholarly journals Influence of the local anesthetics solutions’ temperature on muscular action potential amplitude decrease at brachial plexus block

2012 ◽  
Vol 93 (6) ◽  
pp. 907-910
Author(s):  
R R Safin ◽  
O G Anisimov
Keyword(s):  
Action Potential ◽  
Brachial Plexus ◽  
Local Anesthetics ◽  
Brachial Plexus Block ◽  
Main Group ◽  
Control Group ◽  
Action Potential Amplitude ◽  
Plexus Block ◽  
Amplitude Decrease ◽  
Muscular Action

Aim. To study influence of temperature of local anesthetics solutions on effectiveness of brachial plexus block using axillary access. Methods. Patients who underwent arm and hand surgeries were randomized either to the main group (n=25) or to the control group (n=25). In the main group, 1% lidocaine (20 ml) and 0.25% ropivacaine (40 ml - males, 30 ml - females) at 38 °C were used for brachial plexus block using axillary access. In the control group, anesthetics at room temperature were used. Brachial plexus block was performed using the axillary access at m. pectoralis major margin above the a. axillaris pulsation point. To register provoked muscular action potentials, a portative neurodiagnostic system «Nicolet One» was used. The percentage of provoked muscular action potential amplitude decrease was counted with results of a measurement before the block as a baseline. For additional analgesia and sedation phentanylum 0.005% was used until Ramsay sedation score II was achieved. «EZSAT-E» software package was used for data analysis. Results. In the main group brachial plexus block was achieved 14.2±3.4 minutes earlier than in the control group. Phentanylum dose required to provide psychic and emotional comfort was 45.4% lower in the main group (3.0±0.9 μg/kg per hour) compared to the control group (5.5±1.7 μg/kg per hour). Conclusion. The use of local anesthetics solutions at body temperature increases the efficiency of brachial plexus block and reduces the time of it’s achievement, increases it’s analgesic potential and decreases the need for narcotic analgesics to provide psychic and emotional comfort for the patient.

scholarly journals Dexamethasone with Local Anesthetics Versus Local Anesthetics Alone in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A N Elshaer ◽  
S G A Said ◽  
D S Alawady ◽  
A M Reyad
Keyword(s):  
Brachial Plexus ◽  
Nerve Block ◽  
Local Anesthetics ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Control Group ◽  
Nerve Blocks ◽  
Supraclavicular Brachial Plexus Block ◽  
Prolonged Hospital ◽  
Plexus Block

Abstract Background Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stays and an increased likelihood of chronic pain. Systemic analgesics (opioids and non-opioids) have long been used for postoperative pain, then neuroaxial or peripheral nerve blocks were employed. Local anesthetics alone were used, then various adjuvants were added to achieve quick, dense and prolonged block. Objective The aim of this study was to study the effect of dexamethasone as an adjuvant to bupivacaine in supraclavicular brachial plexus block. The comparison included the onset and the duration of the sensory and motor blocks, the duration of analgesia of the block as well as their effects on the postoperative analgesic requirements. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done. Patients and Methods In our study, 60 patients were randomly divided into 2 equal groups. Control group received bupivacaine only (0.5%) and dexa group in which 8 mg of dexamethasone were added to bupivacaine. All patients received equal volumes of 20 milliliters. Results Our study showed that addition of 8 milligrams of dexamethasone to bupivacaine in ultrasound-guided supraclavicular nerve block shortened the onset times of motor blocks and significantly prolonged motor and sensory block durations. In addition, dexamethasone prolonged the duration of analgesia of the plexus block significantly, as proved by the time of request of analgesia. Moreover, in dexa group, postoperative analgesic requirements were greatly lesser than that of bupivacaine groups. Addition of dexamethasone also did not affect the hemodynamics to a significant level. This makes dexamethasone with bupivacaine more superior than the use of bupivacaine alone. Conclusion Addition of dexamethasone to bupivacaine in supraclavicular nerve block shortened the onset motor blocks. Addition of dexamethasone to bupivacaine significantly prolongs of both sensory and motor block durations.

scholarly journals Local Anesthetic-Induced Central Nervous System Toxicity during Interscalene Brachial Plexus Block: A Case Series Study of Three Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 1013
Author(s):  
Daniel Spitzer ◽  
Katharina J. Wenger ◽  
Vanessa Neef ◽  
Iris Divé ◽  
Martin A. Schaller-Paule ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Brachial Plexus ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Brachial Plexus Block ◽  
Central Nervous System Toxicity ◽  
Interscalene Brachial Plexus Block ◽  
Plexus Block ◽  
System Toxicity

Local anesthetics are commonly administered by nuchal infiltration to provide a temporary interscalene brachial plexus block (ISB) in a surgical setting. Although less commonly reported, local anesthetics can induce central nervous system toxicity. In this case study, we present three patients with acute central nervous system toxicity induced by local anesthetics applied during ISB with emphasis on neurological symptoms, key neuroradiological findings and functional outcome. Medical history, clinical and imaging findings, and outcome of three patients with local anesthetic-induced toxic left hemisphere syndrome during left ISB were analyzed. All patients were admitted to our neurological intensive care unit between November 2016 and September 2019. All three patients presented in poor clinical condition with impaired consciousness and left hemisphere syndrome. Electroencephalography revealed slow wave activity in the affected hemisphere of all patients. Seizure activity with progression to status epilepticus was observed in one patient. In two out of three patients, cortical FLAIR hyperintensities and restricted diffusion in the territory of the left internal carotid artery were observed in magnetic resonance imaging. Assessment of neurological severity scores revealed spontaneous partial reversibility of neurological symptoms. Local anesthetic-induced CNS toxicity during ISB can lead to severe neurological impairment and anatomically variable cerebral lesions.

scholarly journals Comparison of effects of dexmedetomidine and clonidine as adjuvant to bupivacaine 0.25% in ultrasound guided supraclavicular brachial plexus block

2017 ◽  
Vol 5 (10) ◽  
pp. 4512 ◽  
Author(s):  
Usha K. Chaudhary ◽  
Amruth Danesh ◽  
Monika Mahajan ◽  
Sudarshan Kumar ◽  
Versha Verma ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Categorical Variables ◽  
Control Group ◽  
Double Blind Study ◽  
Continuous Variables ◽  
Ultrasound Guided ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: Ultrasound guided brachial plexus block is the preferred technique for surgeries on upper limb. Adjuvants are usually added to peripheral nerve blocks to increase their analgesic efficiency and duration. We compared analgesic effects of dexmedetomidine 1mcg/kg and clonidine 1mcg/kg as adjuvant to a low volume of bupivacaine in USG guided supraclavicular brachial plexus block.Methods: A prospective, randomized controlled, double blind study planned after permission from institutional ethics committee. Sixty ASA grade I, II patients, 18-60 years undergoing upper limb orthopedic surgery included. Group 1 (Control group) received 20 ml of 0.25% bupivacaine. Group 2 (Dexmedetomidine group) received 20ml of bupivacaine + dexmedetomidine (10 ml of 0.5% bupivacaine + 1µg/kg of dexmedetomidine, diluted with 0.9% NS to 20 ml) Group 3 (Clonidine group) received 20 ml of 0.25 bupivacaine + clonidine (10ml of 0.5% bupivacaine+1µ g/kg of clonidine, diluted with 0.9% NS to 20 ml) in USG guided supraclavicular brachial plexus block. Continuous variables analyzed with analysis of variance or Kruskal-Wallis test and categorical variables with Fisher’s exact test.Results: Pain free period was 864.90±357.16 minutes: dexmedetomidine group; 584.59±172.38 minutes: clonidine group, 431.78±138.40 minutes: control group with p< 0.001. VRS (verbal rating score) was significantly higher in control group as compared to dexmedetomidine at 4 hours but the pain scores were comparable between all the groups after 8 hours of block.Conclusions: Dexmedetomidine as an adjuvant to bupivacaine provides prolonged anaesthesia, better pain relief in early postoperative period with haemodynamically stable, calm patients compared to clonidine and control group.

scholarly journals A Comparative Study of Addition of Midazolam to Lignocaine—Bupivacaine vs only Lignocaine— Bupivacaine in Brachial Plexus Block

2016 ◽  
Vol 1 (1) ◽  
pp. 5-9
Author(s):  
Naina P Dalvi ◽  
Harshali Salunkhay ◽  
Shubha N Mohite
Keyword(s):  
Comparative Study ◽  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Control Group ◽  
Study Group ◽  
Motor Blockade ◽  
Peripheral Nerve Stimulator ◽  
Sensory Blockade ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

ABSTRACT Introduction This prospective, randomized, double-blind study compared the onset and duration of sensory blockade, motor blockade, and analgesia with lignocaine, bupivacaine, and midazolam combination vs only lignocaine, bupivacaine in brachial plexus block. Materials and methods Patients of either sex, aged 18–60 years, American Society of Anesthesiologists grade I/II, posted for upper limb surgeries to be performed under supraclavicular brachial plexus block with the help of peripheral nerve stimulator were administered either 10 ml 0.5% bupivacaine with 50 μg/kg midazolam (preservative free) + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine– bupivacaine–midazolam (LBM) or 10 ml 0.5% bupivacaine + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine–bupivacaine (LB). Onset and duration of sensory and motor blockade were monitored. Postoperative analgesia was graded with visual analog scale. Sedation was monitored with Ramsey sedation score. Results A total of 60 patients were randomized to the group LBM (n = 30) and group LB (n = 30). The analgesia was significantly prolonged in the study group, with a mean of 11.72 ± 1.924 hours as compared with a mean of 6.383 ± 1.031 hours in the control group. Sedation scores were higher in the study group, that is, group LBM compared to group LB postoperatively. Conclusion In conclusion, midazolam when added to bupivacaine and adrenalized lignocaine for supraclavicular brachial plexus block hastens the onset of sensory and motor blockade. This combination improves analgesia, as manifested by lower pain scores and prolonged duration of analgesia. How to cite this article Dalvi NP, Salunkhay H, Mohite SN. A Comparative Study of Addition of Midazolam to Lignocaine–Bupivacaine vs only Lignocaine–Bupivacaine in Brachial Plexus Block. Res Inno in Anaesth 2016;1(1):5-9.

scholarly journals Comparative study between Fentanyl with (Lidocaine and Bupivicaine) Versus (Lidocaine and Bupivicaine) alone in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S A Elsebaay ◽  
H A Elgendy ◽  
M M Afifi
Keyword(s):  
Comparative Study ◽  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Lidocaine Hydrochloride ◽  
Control Group ◽  
Supraclavicular Brachial Plexus Block ◽  
Group B ◽  
Plexus Block ◽  
Fentanyl Group

Abstract Background Post operative pain and stress is a very known complication of many surgical procedures which represents a burden for the patient and associated with many complications including stress, myocardial ischemia, prolonged hospital stay and the need of extensive post operative analgesia. Aim of the Work to study the effect of Fentanyl as an adjuvant to bupivacaine and Lidocaine in supraclavicular brachial plexus block. After taking approval from Local Ethical Committee approval and informed written consent from each patient, this randomized prospective comparative study was conducted on 60 patients who were divided into two groups: Group A (Control group): 20 ml of 0.5% bupivacaine + 6 ml of lidocaine hydrochloride 2% + 1 ml of Normal Saline 0.9%. Group B (Fentanyl group): 20 ml of 0.5% bupivacaine + 6 ml of lidocaine hydrochloride 2% + 1ml of fentanyl 50 ug/ml. Results our study showed that addition of a 50 microgram of fentanyl to bupivacaine and lidocaine in ultrasound-guided supraclavicular nerve block has statistically significant effect on the onset of sensory and motor block and prolonged the duration of the sensory and the motor block. In addition, fentanyl prolonged the duration of analgesia of the plexus block significantly, as proved by the time of request of first analgesia. Moreover, in fentanyl group, postoperative analgesic requirements were greatly lesser than that of bupivacaine and lidocaine groups. Addition of fentanyl also did not affect the hemodynamic to a significant level Conclusion fentanyl with bupivacaine and lidocaine more superior than the use of bupivacaine and lidocaine alone.

A rat model of nerve stimulator-guided brachial plexus blockade

2018 ◽  
Vol 53 (2) ◽  
pp. 160-168
Author(s):  
Yanzi Zhang ◽  
Bo Cui ◽  
Chunyu Gong ◽  
Yidan Tang ◽  
Jianxiong Zhou ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Rat Model ◽  
Local Anesthetics ◽  
Brachial Plexus Block ◽  
Motor Blockade ◽  
Efficacy And Safety ◽  
Nerve Stimulator ◽  
Sensory Blockade ◽  
Brachial Plexus Blockade ◽  
Plexus Block

It is important to develop a feasible animal model of regional anesthesia other than sciatic nerve blockade for pharmacokinetic investigations of new local anesthetics or analgesia in upper extremity surgery. Herein, we explored a nerve stimulator (NS)-guided brachial plexus block (BPB) in a rat model. The anatomy of the brachial plexus in rats was delineated in cadavers, and various BPBs were examined. The puncture point was located 0.5–1.0 cm below the lateral one-third of the clavicle. The efficacy and safety of the NS-guided BPB were evaluated using an injection of 2% lidocaine or 0.5% bupivacaine in 16 live animals; saline injection was used as a control. Both sides of the brachial plexus were located successfully using the NS-guided technique. Sensory blockade (nociception assessment) and motor blockade (grasping and straightening tests) appeared after application of the two classical local anesthetics, but not normal saline. The motor and sensory blockade induced by bupivacaine exhibited a longer duration than that induced by lidocaine ( p < 0.05). All rats recovered uneventfully from general anesthesia and BPB. No abnormal results were found in pathological studies or behavioral observations. Thus, a rat model of NS-guided BPB was established, and BPB induced an overall reversible sensory and motor blockade in the thoracic limbs. Evaluation of the efficacy and safety demonstrated that this rat BPB model was feasible, reproducible, and safe.

scholarly journals Comparative Study between Ketamine and Magnesium Sulfate as Adjuvant to Bupivacaine in Ultrasound Guided Supra-Clavicular Brachial Plexus Block

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A Y Ibrahim ◽  
H A Labib ◽  
H F A Toulan ◽  
E A Deabes
Keyword(s):  
Brachial Plexus ◽  
Magnesium Sulfate ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
University Hospital ◽  
Control Group ◽  
Significant Difference ◽  
Plexus Block

Abstract Background In modern anesthesia practice, peripheral nerve block has a significant contributory role. Safety and accepted success rate have made this technique of anesthesia as very popular in ambulatory and inpatient anesthesia. Aim of the Work is to compare onset, degree of blockade, duration of blockade, duration of postoperative analgesia, and associated side effects after adding either magnesium sulfate or Ketamine to bupivacaine for performing supraclavicular Brachial Plexus Blocks for upper-limb surgeries. Patients and Methods After obtaining approval from the Research Ethical Committee of Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospital. Randomized controlled double blinded study. Results Regarding the assessment of sensory block in the study, Onset times (mean ± SD) were (22.15 ± 3.20) mins, (17.35 ± 4.12) and (15.42 ± 3.23) mins in control, Magnesium and ketamin groups respectively. Adding ketamine or Magnesium significantly fastened the onset of sensory block with a highly significant difference (P &lt; 0.001) in comparison to control group. These results also demonstrated that Ketamin fastened the onset time more than Magnesium but there was no statistically significant difference between two groups. Conclusion Ultrasound guidance should be used as a routine technique for brachial plexus block and anaesthetists should gain experience in the application of ultrasound in all nerve blocks. Lower volumes and different types and concentrations of local anaesthetics should be tried in order to maintain effectiveness and decrease incidence of complications. Different doses of ketamin and magnesium sulfate should be tried to detect the ideal dose to be used as additive to local anaesthetics.

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