Search

Introduction: Upper limb surgeries frequently use the brachial plexus block for anesthetizing the limb. The conventional approach by eliciting paresthesia is a blind procedure that may have a higher failure rate and cancause damage to the nerves and nearby structures. Peripheral nerve stimulator and ultrasound techniques were introduced to aid in better localization of the nerve/plexus avoiding tissue damage. With excellent localization and increased safety margin, ultrasound has increased the success rate of supraclavicular brachial plexus block. The purpose of this study was to compare the effectiveness of a Peripheral nerve stimulator with Ultrasound for giving Supraclavicular brachial plexus block. Material and Methods: After obtaining the Institutional ethical committee approval and patient consent, a total of 60 patients were enrolled in this prospective randomized study which were randomly divided into two groups in whom Supraclavicular brachial plexus block was given using either Peripheral nerve stimulator (Group PNS) or Ultrasound (Group USG). Both groups received 15 ml 0.5% Bupivacaine and 10 ml Lignocaine with Adrenaline {2%}[1;200,000]. The chiefparameters considered were time of onset of sensory and motor block, duration of analgesia, block failure and complications following block. Results: Demographic data was comparable in both the groups. The mean time of onset of motor block and sensory blockwas found to be more in Group PNS as compared to Group USG. The duration of sensory and motor blockade was more in group PNS ascompared to group USG. The success rate of the block was higher in ultrasound group than inPNSgroup however it wasstatisticallyinsignificant. No complications occurred in either group. Conclusion: Ultrasound guidance is a safe and effective method for giving supraclavicular brachial plexus block with faster onset and more lasting duration of motor and sensory blockade. [ABSTRACT FROM AUTHOR]

Introduction: Upper limb surgeries frequently use the brachial plexus blockade method. The conventional approach of treating paresthesia is a blind procedure that may have a higher failure rate and cause damage to the nerves and nearby structures. Peripheral nerve stimulator and ultrasound techniques were introduced to help with better localization of the nerve/plexus in order to avoid some of these issues. With excellent localization and increased safety margin, ultrasound has increased the success rate of supraclavicular brachial plexus blocks. The purpose of this study was to contrast the effectiveness of a Peripheral nerve stimulator with an ultrasound-guided technique brachial plexus block. Material and Methods: After obtaining the Institutional ethical committee approval and patient consent total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: Peripheral nerve stimulator (Group PNS) and ultrasound-guided technique (Group USG). Both groups received 0.5% bupivacaine. The amount of local anesthetic injected calculated according to the body weight and was not crossing the toxic dosage (injection bupivacaine 2 mg/kg). The parameters compared between the two groups were lock execution time, time of onset of sensory and motor block, quality of sensory and motor block success rates were noted. The failed blocks were supplemented with general anesthesia. Results: Demographic data were comparable in both groups. The mean time taken for the procedure to administer a block by eliciting PNS is less compared to USG, and it was statistically significant. The mean time of onset of motor block, sensory blockade, the duration of sensory and motor blockade was statistically significant. The success rate of the block is more in ultrasound group than PNSgroup which was not clinically significant. The incidence of complications was seen more in PNS group. Conclusion: Ultrasound guidance is the safe and effective method for the supraclavicular brachial plexus block. Incidence of complications are less as ultrasound provides real-time visulaization of underlying structures and the spread of local anaesthetic. [ABSTRACT FROM AUTHOR]

Background: In pediatric catheterization, the palpation and landmark (PL) technique is widely used for femoral arterial and venous (FAV) cannulation. Over the past decade, the ultrasound‐guided (US) technique has replaced the PL technique. This study aimed to assess the clinical impact of application of the US technique on the success rate and completion time of FAV cannulation during cardiac catheterization in children. Methods: This is a retrospective observational study of consecutive pediatric patients who underwent cardiac catheterization in a tertiary care children's hospital from April 2016 to March 2022. The association between FAV cannulation success rate and the US technique was analyzed using multiple logistic regression analysis by adjusting for potential confounders, including patient and operator characteristics and procedural details. Results: A total of 749 patients (PL, 378; US, 371) were analyzed. The odds ratio (OR) of the US technique success rate for FAV cannulation was 2.03, 95% confidence interval (CI), 1.10–3.73; p = 0.02. The OR of the cannulation success rate of children aged <1 year was 0.16 (95% CI, 0.03–0.97; p = 0.046). Conclusions: The US‐guided technique was associated with an increased success rate of FAV cannulation, compared with the PL technique. Moreover, age < 1 year was an independent factor associated with a lower success rate of FAV cannulation. The US‐guided technique might be an effective procedure in FAV cannulation during cardiac catheterization in children. [ABSTRACT FROM AUTHOR]

We performed bilateral transmuscular quadratus lumborum blocks in six cadavers using iodinated contrast and methylene blue. Computed tomography imaging was performed in four cadavers and anatomical dissection was completed in five. This demonstrated spread to the lumbar paravertebral space in 63% of specimens, laterally to the transversus abdominis muscle in 50% and caudally to the anterior superior iliac spine in 63% of specimens. There was no radiographic evidence of spread to the thoracic paravertebral space. Anatomical dissection revealed dye staining of the upper branches of the lumbar plexus and the psoas major muscle in 70% of specimens. Further clinical studies are required to confirm if the quadratus lumborum block might be a suitable alternative to lumbar plexus block. [ABSTRACT FROM AUTHOR]

Objective: To investigate a novel method for in-office fitting of intrauterine contraceptive devices (IUCDs) by comparing it to the traditional non-guided technique.Methods: A prospective cohort study comparing the application of intrauterine contraceptives was conducted between January 1, 2013 and January 31, 2015 at a university contraception clinic, in Alexandria, Egypt. Patients aged 20-45years who were parous, had previously undergone vaginal or abdominal deliveries, and were requesting device insertion were included. Patients were randomly assigned to have devices fitted using the non-guided approach, with vaginal ultrasonography to plan and confirm device placement, or by the abdominal ultrasonography-guided technique. The primary outcomes were successful IUCD insertion and ideal device position 1week after insertion. Participants, counselors, and data analysts were masked to treatment assignments.Results: Analyses included 40 patients in each treatment arm. Successful fitting was achieved in 32 (80%) patients in the non-guided arm and 39 (98%) patients in the ultrasonography-guided arm (P=0.04). Ideal placement was achieved in 38 (95%) patients in the ultrasonography-guided arm compared with 27 (68%) patients in the non-guided arm (P=0.02).Conclusion: Ultrasonography-guided IUCD insertion demonstrated improved success and fitting accuracy in comparison with a traditional, non-guided approach. ANZCTR trial ID: ACTRN12615000526572. [ABSTRACT FROM AUTHOR]

Background: Percutaneous central venous cannulation in infants and children is a challenging procedure. Traditionally, an external landmark technique has been used to identify puncture site. An ultrasound-guided technique is now available and we wanted to evaluate this method in children and infants, looking specifically at the ease of use, success rate and complications. Methods: Forty-two consecutive infants and children (median 16.5 [0–177] months and 10 [3–45] kg) scheduled for central venous catheter placement were registered. An ultrasound scanner made for guiding puncture of vessels was used. After locating the puncture site, a sterile procedure was performed using an accompanying kit to aid puncture of the vessel. Results: Cannulation was successful in all patients and we had no complications during insertion of the catheters. The right internal jugular vein was preferred in most patients, and in 95% of the patients the vein was punctured at the first attempt. The median time from start of puncture to aspiration of blood was 12 (3–180) seconds. Conclusion: The ultrasound-guided technique for placement of central venous catheters was easy to apply in infants and children. It is our impression that it increased the precision and safety of the procedure in this group of patients. [ABSTRACT FROM AUTHOR]

Abstract: The combination of hypnosis and paravertebral block (PVB) was studied in three patients scheduled for breast cancer surgery. The three procedures were realized under hypnosis. Median postoperative pain was rated at zero and comfort felt at 8 on a 10 points scale. Hypnosis could be an alternative to conventional anesthesia in combination with a PVB for breast cancer surgery. [Copyright &y& Elsevier]