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Nerve stimulator guided blocks

Andrew T Koogler, Michael Kushelev
A 76-year-old male presented for reverse total shoulder arthroplasty (TSA) in the beach chair position. A preoperative interscalene nerve catheter was placed under direct ultrasound-guidance utilizing a posterior in-plane approach. On POD 2, the catheter was removed. Three weeks postoperatively, the patient reported worsening dyspnea with a subsequent chest X-ray demonstrating an elevated right hemidiaphragm. Pulmonary function testing revealed worsening deficit from presurgical values consistent with phrenic nerve palsy...
2018: Case Reports in Anesthesiology
Rein Ketelaars, Joram T Stollman, Evelien van Eeten, Ties Eikendal, Jörgen Bruhn, Geert-Jan van Geffen
BACKGROUND: The treatment of acute pain in the emergency department is not always optimal. Peripheral nerve blocks using "blind" or nerve stimulator techniques have substantial disadvantages. Ultrasound-guided regional anesthesia may provide quick, safe, and effective pain relief in patients with proximal femoral fractures with severe pain. However, no evidence exists on emergency physician-performed ultrasound-guided regional anesthesia in these patients in Dutch emergency departments...
March 2, 2018: International Journal of Emergency Medicine
Karen Boretsky, Maria A Hernandez, Elizabeth Eastburn, Cornelius Sullivan
BACKGROUND: The clinical reliability and reproducibility of ultrasound-guided lumbar plexus blocks is not established in pediatric populations. We present the results of a combined nerve stimulation ultrasound-guided lumbar plexus block using the vertebral body, transverse process, and psoas muscle as landmarks on a transverse lumbar paravertebral sonogram with mid-axillary transducer placement, "shamrock method," in children and adolescents. AIMS: Our primary objective was to determine the rate of achieving sensory changes in the lumbar plexus distribution...
January 23, 2018: Paediatric Anaesthesia
Li Xiaoqiang, Zhang Xuerong, Liu Juan, Bechu Shelley Mathew, Yin Xiaorong, Wan Qin, Luo Lili, Zhu Yingying, Luo Jun
BACKGROUND: Catheter-related bladder discomfort (CRBD) to an indwelling urinary catheter is defined as a painful urethral discomfort, resistant to conventional opioid therapy, decreasing the quality of postoperative recovery. According to anatomy, the branches of sacral somatic nerves form the afferent nerves of the urethra and bladder triangle, which deriving from the ventral rami of the second to fourth sacral spinal nerves, innervating the urethral muscles and sphincter of the perineum and pelvic floor; as well as providing sensation to the penis and clitoris in males and females, which including the urethra and bladder triangle...
December 2017: Medicine (Baltimore)
Isabelle Gaudet-Ferrand, Pablo De La Arena, Sophie Bringuier, Olivier Raux, Laurent Hertz, Nicolas Kalfa, Chrystelle Sola, Christophe Dadure
BACKGROUND: Transperineal pudendal nerve block guided by nerve stimulator is used in pediatric anesthesia as an alternative to caudal analgesia in perineal surgery. The risk of rectal puncture or intravascular injection is inherent to this blinded technique. We described a new technique of transperineal pudendal nerve block, with ultrasound guidance, to improve safety of the technique. AIMS: The first goal of this study was to describe this new technique and to test its feasibility...
January 2018: Paediatric Anaesthesia
M Fujimoto, K Kawano, T Yamamoto
BACKGROUND: Rocuronium can prevent the obturator jerk during transurethral resection of bladder tumors. We investigated the adequate rocuronium dose required for complete block of the thigh adductor muscles, and its correlation with individual responses of the adductor pollicis muscle to rocuronium. METHODS: Eleven patients scheduled for transurethral resection of bladder tumors under general anesthesia were investigated. After general anesthesia induction, neuromuscular monitoring of the adductor pollicis muscle and ultrasonography-guided stimulation of the obturator nerve was commenced...
March 2018: Acta Anaesthesiologica Scandinavica
Francine D'Ercole, Harendra Arora, Priya A Kumar
Local anesthetic injected into a wedge-shaped space lateral to the spinal nerves as they emerge from the intervertebral foramina produces somatosensory and sympathetic nerve blockade effective for anesthesia and for managing pain of unilateral origin from the chest and abdomen. Paravertebral blockade (PVB) is versatile and may be applied unilaterally or bilaterally. Unlike thoracic epidural, the PVB technique may be used to avoid contralateral sympathectomy, thereby minimizing hypotension and leading to better preservation of blood pressure...
October 4, 2017: Journal of Cardiothoracic and Vascular Anesthesia
Wensheng He, Zhuo Liu, Zhenyu Wu, Wenchao Liu, Haijun Sun, Xiaochun Yang
BACKGROUND: Coracoid approach is efficient and safe for brachial plexus block, and is guided by nerve stimulator or ultrasound in general. Many trials have proved that ultrasonic guidance was more efficacious than nerve stimulator guidance. We hypothesized that positioning posterior cord could enhance the anesthesia effect of coracoid approach brachial plexus block (CABPB) guided by nerve stimulator. METHODS: Eighty patients were randomized into 2 groups to receive CABPB with positioning posterior cord guided by nerve stimulator (group A) or CABPB guided by ultrasound (group B)...
November 2017: Medicine (Baltimore)
Martin Ertmer, Edda Klotz, Jürgen Birnbaum
Regional plexus and nerve blocks are a common technique in modern anesthesia. Since ultrasound machines are available in many departments, the role of nerve stimulation is highly discussed and different approaches to perform the blocks are taken into account. Common technique for electrical nerve stimulation is searching for a stimulating threshold of 0.4-0.5mA using an impulse width of 0.1ms. We present our hypothesis of using all possible information with a new concept of protective nerve stimulation together with first data supporting our theory...
September 2017: Medical Hypotheses
Ranganathan Jothi Abhinaya, Rajagopalan Venkatraman, Palanisamy Matheswaran, Govindarajan Sivarajan
BACKGROUND AND AIMS: The supraclavicular and infraclavicular brachial plexus blocks have a similar distribution of anaesthesia, and both can be used effectively for surgeries of the upper limb. This study aimed to compare the supraclavicular and infraclavicular approaches of brachial plexus blocks, guided by ultrasound and neurostimulation. METHODS: Sixty adult patients scheduled for elective upper limb surgery of the elbow and/or below were randomly divided into two groups: infraclavicular Group (I) and supraclavicular Group (S)...
July 2017: Indian Journal of Anaesthesia
Werner Ten Hoope, Marjolein Looije, Philipp Lirk
PURPOSE OF REVIEW: The aim of this review is to summarize recent relevant literature regarding regional anesthesia in the diabetic neuropathic patient and formulate recommendations for clinical practice. RECENT FINDINGS: Diabetic neuropathic nerves, but not nerves of diabetic patients per se, exhibit complex functional changes. As a result, they seem more sensitive to local anesthetics, and are more difficult to stimulate. When catheters are used postoperatively, diabetes is an independent risk factor for infection...
October 2017: Current Opinion in Anaesthesiology
Zhi-Xue Wang, De-Li Zhang, Xin-Wei Liu, Yan Li, Xiao-Xia Zhang, Ru-Hong Li
Evidence was controversial about whether nerve stimulation (NS) can optimize ultrasound guidance (US)-guided nerve blockade for peripheral nerve block. This review aims to explore the effects of the two combined techniques. We searched EMBASE (from 1974 to March 2015), PubMed (from 1966 to Mar 2015), Medline (from 1966 to Mar 2015), the Cochrane Central Register of Controlled Trials and Finally, 15 randomized trials were included into analysis involving 1,019 lower limb and 696 upper limb surgery cases...
September 2017: IUBMB Life
Michał Jan Stasiowski, Michał Kolny, Marek Zuber, Radosław Marciniak, Ewa Chabierska, Przemysław Jałowiecki, Aleksandra Pluta, Bartłomiej Możdżyński
BACKGROUND: Shoulder arthroscopic procedures impose a challenge to anaesthesiologists in terms of postoperative analgesia. Proper pain management after arthroscopic procedures improves patient satisfaction and facilitates early rehabilitation. METHODS: We performed a randomized, prospective clinical study to assess the influence of anthropometric parameters and IBPB technique on the quality of postoperative analgesia. A total of 106 randomly selected patients of ASA I-III status scheduled for elective shoulder arthroscopy...
2017: Anaesthesiology Intensive Therapy
Kiran Abhayakumar Honnannavar, Mahantesh Shivangouda Mudakanagoudar
INTRODUCTION: Brachial plexus blockade is a time-tested technique for upper limb surgeries. The classical approach using paresthesia technique is a blind technique and may be associated with a higher failure rate and injury to the nerves and surrounding structures. To avoid some of these problems, use of peripheral nerve stimulator and ultrasound techniques were started which allowed better localization of the nerve/plexus. Ultrasound for supraclavicular brachial plexus block has improved the success rate of the block with excellent localization as well as improved safety margin...
April 2017: Anesthesia, Essays and Researches
Nida Farooq Shah, Khalid Parvez Sofi, Showkat Hussain Nengroo
BACKGROUND: Obturator nerve (ON) stimulation during transurethral resection of lateral and posterolateral bladder wall tumor under spinal anesthesia may lead to obturator reflex, adductor contraction, and leg jerking with complications such as bleeding, bladder perforation, or incomplete tumor resection. Our study was carried out to obtain successful block of ON using ultrasound (US)-guided technique with or without nerve stimulation in patients undergoing transurethral resection of bladder tumor (TURBT) under spinal anesthesia...
April 2017: Anesthesia, Essays and Researches
MinHye So, Takeshi Sugiura, Saya Yoshizawa, Kazuya Sobue
In recent years, the technique of combined ultrasound and electrical stimulation-guided nerve block has been recommended. We present 2 patients with Duchenne muscular dystrophy who exhibited different muscle responses to nerve stimulation during the performance of peripheral nerve blocks for surgeries. Whereas a 2-year-old boy without severe disability showed the expected muscle contraction to electrical nerve stimulation, a 14-year-old boy with severe disability showed no muscle response. Our experience suggests that muscle responses to electrical nerve stimulation will vary with the stage of Duchenne muscular dystrophy...
July 15, 2017: A & A Case Reports
Gokhan Demirelli, Semih Baskan, Isil Karabeyoglu, Ismail Aytac, Dilsen Hatice Ornek, Alper Erdogmus, Mustafa Baydar
OBJECTIVE: To evaluate the characteristics of axillary plexus blockade applied using ultrasound only and using ultrasound together with nerve stimulator in patients undergoing planned forearm, wrist or hand surgery. METHODS: This randomised, prospective, double-blinded, single-centre study was conducted at Ankara Numune Training and Research Hospital, Ankara, Turkey, from November 2014 to August 2015, and comprised patients undergoing forearm, wrist or hand surgery...
April 2017: JPMA. the Journal of the Pakistan Medical Association
Lindsay A Zilliox
PURPOSE OF REVIEW: Neuropathic pain is a frequently encountered condition that is often resistant to treatment and is associated with poor patient satisfaction of their treatment. Several medications have been shown to be effective in treating neuropathic pain associated with diabetic neuropathy and postherpetic neuralgia, and these medications are often used to treat neuropathic pain associated with other conditions as well. This article summarizes the diagnosis and assessment of patients with neuropathic pain as well as available pharmacologic and interventional treatment options...
April 2017: Continuum: Lifelong Learning in Neurology
Thiago Mamôru Sakae, Patricia Marchioro, Fabiana Schuelter-Trevisol, Daisson José Trevisol
STUDY OBJECTIVE: The purpose of this study was to evaluate the effect of intravenous or perineural dexamethasone added to ropivacaine on the duration of ultrasound-guided interscalene brachial plexus blocks (BPB). DESIGN: Randomized clinical trial. SETTING, PATIENTS AND INTERVENTIONS: Sixty ASA physical status I-II patients with elective shoulder arthroscopic surgeries under interscalene brachial plexus blocks were randomly allocated to receive 20ml of 0...
May 2017: Journal of Clinical Anesthesia
Michał Kolny, Michał J Stasiowski, Marek Zuber, Radosław Marciniak, Ewa Chabierska, Aleksandra Pluta, Przemysław Jałowiecki, Tomasz Byrczek
BACKGROUND: Interscalene brachial plexus block is an effective regional anesthesia technique for shoulder surgeries. The superiority of the popular ultrasound-guided blocks over peripheral nerve stimulator-confirmed blocks remains unclear. In this study the efficacy of these different block techniques was compared. METHODS: This prospective, randomized, clinical study included 109 patients (ASA grades I-III) who receive 20 mL 0.5% ropivacaine with ultrasound-guided blocks (U group), peripheral nerve stimulator-confirmed blocks (N group), or ultrasound-guided and peripheral nerve stimulator-confirmed blocks (dual guidance; NU group) for elective shoulder arthroscopy...
2017: Anaesthesiology Intensive Therapy
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