Search

To develop an ultrasound (US)-guided ventral approach to the brachial plexus (BP) and evaluate nerve anatomy and staining in barred owl cadavers. Prospective, cadaveric study. Eleven adult male and female barred owl cadavers with a body mass of 0.43–0.98 kg. Eleven frozen cadavers were thawed for 48 hours, weighed and assigned a body condition score. Ten cadavers were placed in dorsal recumbency with wings abducted. US-guided visualization of the BP was achieved by placing a 13-6 MHz linear probe over the ventral aspect of the scapulohumeral joint, parallel to the sternum. A 22 gauge, 50 mm insulated needle was advanced in-plane in a caudal-to-cranial direction. In each owl, injection targeting one BP was performed with 0.4 mL kg–1 of a 1:1 0.5% ropivacaine and 1% methylene blue solution. Dissection was performed 15 minutes postinjection. Nerve staining was deemed successful if ≥ 1 cm of circumferential staining was achieved. The eleventh owl cadaver was injected with a 1:1 solution of 1% methylene blue and 74% ioversol contrast into both wings, and computed tomography (CT) was performed just before and 15 minutes after injection. The BP was clearly identified ultrasonographically in cadavers weighing > 0.5 kg. An injectate volume of 0.4 mL kg–1 provided complete staining of the BP branches in all cadavers. CT scan revealed no contrast within the coelomic cavity. The US-guided BP injection using a ventral approach was easily performed in barred owl cadavers weighing > 0.5 kg. The injection of 0.4 mL kg–1 of a ropivacaine–dye solution resulted in complete staining of the BP branches in all wings, suggesting that this technique could provide analgesia for structures distal to the scapulohumeral joint. Clinical studies are necessary to confirm the safety and efficacy of this technique in barred owls and other bird species. [ABSTRACT FROM AUTHOR]

Background: Acute pain is a major concern after arthroscopic shoulder surgery, supraclavicular brachial plexus blockade has shown favorable postoperative analgesic effects. However, its duration of analgesia does not meet clinical needs. We aimed to explore whether the combination of different local anesthetic adjunct can prolong the analgesic duration of supraclavicular brachial plexus block for arthroscopic shoulder surgery. Methods: In this prospective randomized controlled trial, we allocated 80 patients into four groups: Group DMD (dexamethasone 10 mg + ropivacaine 100 mg + dexmedetomidine 50 µg + magnesium sulfate 250 mg), Group DM (ropivacaine 100 mg + dexmedetomidine 50 µg + magnesium sulfate 250 mg), Group M (ropivacaine 100 mg + magnesium sulfate 250 mg) and Group D (ropivacaine 100 mg + dexmedetomidine 50 µg). The primary outcome was the time to first request for analgesia. Secondary outcome measures included cumulative opioid consumption at 6, 12, 18, 24, and 48 h postoperatively, VAS scores at 6, 12, 18, 24, and 48 h postoperatively and so on. Results: The time to first request for analgesia in Group DMD was significantly longer than Group DM (P = 0.011) and Group M (P = 0.003). The cumulative opioid consumption at 18 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.002) and Group M (P = 0.007). The cumulative opioid consumption at 24 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.016). The VAS score at 6 h postoperatively in Group DMD was significantly lower than in Group DM and Group M. The VAS score at 12 h postoperatively in Group DMD was significantly lower than in Group M. For American Shoulder and Elbow Surgeons Score, Group DMD had a better score than Group DM and Group D. Conclusions: The analgesic efficacy of supraclavicular brachial plexus blockade combined with dexamethasone, magnesium sulfate, and dexmedetomidine is significantly superior to the combination of magnesium sulfate and dexmedetomidine, and significantly superior to the use of magnesium sulfate alone. Trial registration: This trial was registered in Chinese Clinical Trial Registry. (ChiCTR2200061181, Date of registration: June 15, 2022, http://www.chictr.org.cn) [ABSTRACT FROM AUTHOR]

Copyright of Agri: Journal of the Turkish Society of Algology / Türk Algoloji (Ağrı) Derneği'nin Yayın Organıdır is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The incidence of hemidiaphragmatic paresis (HDP) in superior trunk block (STB) usually depends on the dose of local anesthetic. This study aimed to further evaluate the impact of a lower volume (10 mL) of the same low concentration (0.25%) ropivacaine compared to a conventional volume (15 mL), on diaphragmatic function and analgesic efficacy under a multimodal analgesia regimen for shoulder arthroscopy. Methods: Patients scheduled to undergo shoulder arthroscopy were randomized allocated to receive either 10 mL or 15 mL of 0.25% ropivacaine in the STB under ultrasound guidance prior to general anesthesia. The primary outcome was the percentage reduction in diaphragm excursion (ΔDE) between baseline and 30 min after block. Secondary outcomes included DE and diaphragm thickening fraction (DTF) before and after block, incidence of HDP, onset of sensory/motor block, duration of analgesia/motor block, dermatomal coverage area of the block, postoperative pain severity, pre- and post-block respiratory function and intraoperative hemodynamic parameters, the use of other anesthetic and analgesic drugs, post-block complications, and adverse events post-surgery. Results: Compared with 15 mL volume, 10 mL ropivacaine significantly reduced the incidence of post-block HDP (as measured by ΔDE: 39.47% vs. 64.10%; and by post-block DTF: 13.16% vs. 33.33%). There was no significant difference in onset of sensory block, duration of analgesia/motor block, dermatomal coverage area of the block, postoperative pain severity between the two groups, except that the onset of motor block was significantly slower in the 10 mL group than in the 15 mL group. Pre- and post-block respiratory function and intraoperative hemodynamic parameters, the use of other anesthetic and analgesic drugs, post-block complications, or postoperative adverse events were not significantly different between the two groups. Conclusion: In shoulder arthroscopy, STB with 10 mL of ropivacaine can reduce the incidence of HDP with no significant difference in analgesic effects under a multimodal analgesia regimen compared with 15 mL. Trial registration: We registered the study at chictr.org (ChiCTR2200057543 , 14/03/2022. https://www.chictr.ogr.cn [ABSTRACT FROM AUTHOR]

Introduction: Fascial plane blocks play a major role in aiding Enhanced Recovery After Surgery (ERAS) following upper abdominal wall surgeries. The External Oblique Intercostal (EOIC) plane block is a novel technique that targets the anterior and lateral cutaneous branches of the thoracoabdominal nerves. Aim: To compare the efficacy of the EOIC plane block with the Transversus Abdominis Plane (TAP) block. Materials and Methods: This double-blinded randomised clinical study was conducted at Narayana Medical College, Nellore, Andhra Pradesh, India, between June 3, 2023, and February 25, 2024, on 100 patients after obtaining ethical committee approval. These patients underwent upper abdominal surgeries, with 50 patients receiving bilateral EOIC block (Group E) and 50 patients receiving bilateral TAP block (Group T) using 0.25% Levobupivacaine and 8 mg Dexamethasone in a total volume of 30 mL on each side. The demographic details studied included age, sex, American Society of Anaesthesiologists (ASA) physical status, weight and key parameters such as dermatomal distribution, extent of analgesia, Numerical Rating Scale (NRS), time for first rescue analgesia, number of rescue analgesic doses and the Bruggemann comfort scale. Data were analysed using the Chi-square test for categorical data and the unpaired Student's t-test for numerical data. Results: The demographic data did not differ significantly between the groups. Both groups had comparable average ages (Group E: 66.8 years; Group T: 67.1 years) and similar gender distributions. The distribution of patients across ASA classifications I, II and III, as well as heights and body weights, was also statistically similar and lacked significant differences. Patients who received the EOIC block exhibited greater dermatomal blockade from T4 to T10 in the midclavicular, anterior axillary and midaxillary lines compared to those who received the TAP block. The NRS scores at 6, 12 and 24 hours after surgery in Group E were lower than in Group T. The time taken for the first rescue analgesia was 12±4.2 hours in Group E compared to 4.4±3.02 hours in Group T, which was statistically significant. The number of rescue analgesic doses was 1.06±0.84 in Group E, compared to 3.52±1.3 in Group T, which was also significant (p<0.05). The Bruggemann comfort scale was superior in Group E compared to Group T, with statistical significance. Conclusion: The EOIC block is a superior and effective alternative to the TAP block for postoperative analgesia in laparoscopic upper abdominal wall surgeries. The extent of analgesia and dermatomal distribution of the EOIC block was greater than that of the TAP block, making the EOIC block more efficacious. [ABSTRACT FROM AUTHOR]

Background: Postoperative analgesia is crucial for recovery after lower limb orthopedic surgeries. The fascia iliaca compartment block (FICB) is widely utilized for pain management, with varying techniques impacting its efficacy. Objective: To compare the efficacy and safety of the suprainguinal versus infrainguinal approaches of FICB in patients undergoing lower limb orthopedic surgeries. Methods: This randomized controlled trial included 200 patients divided equally between the suprainguinal and infrainguinal block approaches. Efficacy was evaluated based on postoperative pain scores and opioid consumption, while safety was assessed by the incidence of complications. Data were analyzed using chi-square and t-tests, with significance set at p<0.05. Results: The suprainguinal approach resulted in significantly lower pain scores (p=0.02) and reduced opioid consumption (p=0.01) compared to the infrainguinal approach. The effectiveness rates were 78.64% for the suprainguinal and 77.66% for the infrainguinal group. Both approaches demonstrated a high safety profile with no significant difference in complication rates (p>0.05). Conclusion: The suprainguinal approach to FICB provides better postoperative analgesia with less opioid requirement than the infrainguinal approach in patients undergoing lower limb orthopedic surgeries. Future studies should focus on long-term outcomes and cost-effectiveness to validate these findings further. [ABSTRACT FROM AUTHOR]

Background: Supraclavicular brachial plexus blockade (SBPB) is commonly performed regional anesthetic technique for forearm and hand surgeries, and its blockage provides good surgical anesthesia. Aim: Considering the efficacy of adjuvant for ropivacaine in SBPBs, we designed a double-blind randomized control study to compare the characteristics and side effects of ropivacaine along with dexamethasone versus dexmedetomidine in SBPBs in patients scheduled for upper limb surgeries. Material and Methods: Present study was single-center, prospective, randomised, double blind study, conducted patients aged 18-70 years, belonging to American Society of Anaesthesiologists physical status (ASA) of I or II, scheduled for Upper limb surgeries under SBPB. Results: In present study, 108 patients were studied, 54 patients received 20 ml 0.5% Ropivacaine with 50 mcg Dexamethasone (Group A, n=54), while other 54 patients received 20 ml 0.5% Ropivacaine with 50 mcg Dexmedetomidine (Group B, n=54). Age, weight, gender, ASA grade & duration of surgery were comparable in both groups. Dexamethasone group has earlier onset of sensory block, earlier onset of motor block, prolonged duration of sensory block & prolonged duration of motor block as compared to dexmedetomidine group & difference was statistically significant (p< 0.05). Dexamethasone group duration of analgesia, delayed first rescue analgesic requirement & less doses of rescue analgesia required as compared to dexmedetomidine group & difference was statistically significant (p< 0.05). Conclusion: Dexamethasone is a better alternative than dexmedetomidine since it shortens the onset of sensory and motor block, prolongs the duration of sensory and motor block and prolongs the duration of analgesia. [ABSTRACT FROM AUTHOR]

To compare efficacy and safety of two different doses of Dexmedetomidine as an adjuvant to Ropivacaine compared to Ropivacaine in block and intravenously Dexmedetomidine in upper limb surgeries under supraclavicular brachial plexus block. INTRODUCTION Supraclavicular block is a reliable, rapid-onset approach to brachial plexus anaesthesia. The supraclavicular block provides anesthesia and analgesia to the upper extremity below the shoulder. It is an excellent choice for elbow and hand surgery. Adjuvants are added to local anesthetics in peripheral nerve blocks to fasten the onset of action, to prolong the duration of action and improve the quality of blockade. Various adjuvants like morphine, fentanyl, sufentanil, clonidine, midazolam, ketamine, neostigmine, dexmedetomidine are added to local anesthetics. Since dexmedetomidine has α2:α1 selectivity ratio of 1620:1 as compared to 220:1 for clonidine, it decreases unwanted side effects of α1 and much more sedative and analgesic. Ropivacaine is a long-acting amide local anaesthetic agent and first produced as a pure enantiomer structurally related to Bupivacaine. Dexmedetomidineis d-enantiomer of medetomidine. It belongs to imidazole subclass of α2 receptor agonist. It is a newer α2-adrenoreceptor agonist is currently in focus for its sedative, anxiolytic and analgesic properties.It is rapidly distributed and metabolized in liver, excreted in urine and faeces. [ABSTRACT FROM AUTHOR]

BACKGROUND In this study we aim to compare two regional Anaesthesia techniques - the axillary brachial plexus block and Bier’s Block intravenous regional anesthesia (IVRA), with respect to the onset of analgesia, degree of sensory and motor blockade, duration of analgesia, and complications. MATERIALS AND METHODS The study was conducted on patients who were admitted to SVRRGGH, Tirupati for elective and urgent procedures of the upper limb below the elbow. In the current study, 60 patients were randomized into two groups of 30 patients each. Group I received an axillary brachial plexus block, while Group II received Bier’s block (IVRA). Patients were of either gender and between the ages of 18 and 50, came for either emergency or planned procedures below the elbow joint. RESULTS In comparing the duration of analgesia between the two atudy groups, the axillary block analgesia had a mean duration of 67.5 minutes while Bier's block lasted upto 46.8 minutes. CONCLUSION With regard to the onset of analgesia, the quality of the analgesia, and the degree of motor blockade, IVRA appears to be a better alternative based on the conclusions of the current study and recommendations from prior references. [ABSTRACT FROM AUTHOR]

Background: Musculocutaneous nerve (MCN) is a mixed nerve arising from the lateral cord of brachial plexus having root values C5, 6, and 7. It supplies the muscles of the flexor compartment of the arm namely; coracobrachialis, most part of brachialis and both heads of biceps brachii. It is cutaneous to the lower lateral part of forearm. Variations in the origin, course, branching pattern, termination, and connections of MCN are very common. Knowledge about these variations is important while evaluating unusual presentations of peripheral nerve injuries, during surgical procedures such as arthroscopy of shoulder joint, corrections of fracture humerus, brachial plexus block, and so on. Aims and Objectives: The study was conducted to find out any variations in the origin, course, branching pattern of the MCN. The secondary objective was to understand about the communication of the MCN with any other nerve. Materials and Methods: A descriptive study was conducted in 60 upper limb specimens dissected from 10% formalin embalmed 30 cadavers (adult) in the Department of Anatomy, Government Medical College, Kottayam. All limbs were carefully dissected and studied about the origin, course, termination, and variations of MCN. Results: Out of 60 specimens studied, in 46 specimens MCN Originate from lateral cord, eight from medial cord, and in six from the lateral root of the median nerve (MN). In 52 specimens, MCN supplies coracobrachialis but only in 34 it pierces this muscle. In four specimens, there is a communication between MCN and MN was seen. Conclusion: The MCN has significant variations and knowledge of these variations is clinically important in diagnosis and management of peripheral nerve injuries as well as surgical interventions in the arm. [ABSTRACT FROM AUTHOR]

To investigate the efficacy of ultrasound-guided interscalene brachial plexus block in the treatment of shoulder pain following hepatectomy. Design: A randomized controlled trial. Methods: We conducted a single-center, randomized controlled trial. Forty-four patients with shoulder pain scores of at least 5 were randomly assigned to two groups: the treatment group, which received 0.5% ropivacaine (5mL) combined with dexamethasone (5 mg) (n=22), and the control group, which received normal saline (5mL) (n=22). The intervention was performed in the postanesthesia care unit after shoulder pain was identified by using the visual analogue scale. The shoulder pain was re-evaluated 15 minutes after intervention. The incidence of effective pain relief, defined as at least 75% reduction in pain intensity, was the primary outcome. Secondary outcomes included shoulder pain intensity within 2 days after surgery, the timing of the first rescue analgesia, total additional analgesic use, arterial oxygen saturation, intervention-related adverse reactions, and patient satisfaction regarding shoulder pain. Results: The incidence of effective pain relief was significantly higher in the treatment group compared to the control group (15 (68.2%) vs 2 (9.1%), P< 0.001). The interscalene brachial plexus block not only prolonged the time to first analgesic request (P < 0.001), but also reduced the number of analgesic requests (P < 0.001). In the comparison between groups, arterial oxygen saturation was lower in the control group than that in the treatment group, attributed to the use of sufentanil for remedial analgesia (92.4% vs 94.5%, P=0.014). Conclusion: Interscalene brachial plexus block can effectively relieve post-hepatectomy shoulder pain without clinically significant hypoxemia. [ABSTRACT FROM AUTHOR]

Background: Supraclavicular brachial plexus block (BPB) is being utilized extensively for upper limb surgeries. To improve block quality, several adjuvants have been used successfully. Fentanyl and dexmedetomidine has been evaluated as adjuvants for such block done using ropivacaine. However, block qualities have been modified to a variable extent with use of such adjuvants. Aims and Objectives: Hence, the study was designed to compare fentanyl and dexmedetomidine as adjuvants during ropivacaine-induced supraclavicular BPB. Materials and Methods: Sixty adults undergoing upper limb surgeries were randomly divided in to two groups to receive either fentanyl or dexmedetomidine as adjuvants to ropivacaine for supraclavicular BPB. The onset of sensory block was the primary outcome measure. Duration of sensory bloc, motor block characteristics, and adverse events were also evaluated. Results: Considerably faster onset of sensory and motor blockade was found with the use of fentanyl as adjuvant over dexmedetomidine (sensory, 8.2±1.19 vs. 12.07±0.96, P

Background: Clavicular brachial plexus blocks are a popular method to provide analgesia in upper limb surgery. Two common approaches include the infraclavicular (IC) and supraclavicular (SC) blocks. These two techniques have been compared previously; however, it is still being determined from the current literature whether one should be favoured. Methods: A search was performed on the following databases: Ovid Medline, EMBASE and the Web of Science from inception until 30.04.2023. All RCTs comparing SC and IC approaches in upper limb orthopaedic surgery were included. The primary outcome was block success rate. Results: Eighteen RCTs comprising 1389 patients were included. The success rate of IC blocks was higher than SC blocks, odds ratio 0.61 (95% CI 0.41–0.91, p = 0.01). A small number of studies reported on secondary outcomes. A reduced rate of Horner's syndrome was observed in the IC group. Otherwise, no difference was noted between the approaches in terms of procedure time, sensory onset time, patient satisfaction, pain and vascular puncture. Conclusion: IC blocks demonstrate a higher success rate over SC blocks. Across all studies a large variance in outcome reporting and definitions was observed. Future studies should conform to an agreed definition set to facilitate comparison. [ABSTRACT FROM AUTHOR]

Background and Aims: Perineural catheters inserted through the costoclavicular (CC) technique of infraclavicular brachial plexus are helpful for postoperative analgesia. This trial compared postoperative local anaesthetic (LA) consumption in an ultrasound (US)-guided perineural catheter inserted by the CC technique with the conventional lateral sagittal (LS) technique. Methods: Eighty American Society of Anesthesiologists (ASA) I/II patients scheduled for upper limb orthopaedic surgery were randomly assigned to receive a perineural catheter by either the CC technique (Group CC) or LS technique (Group LS). Postoperatively, all patients received patient-controlled regional analgesia (PCRA): bolus-only regime with 0.125% bupivacaine 6 ml and a lock-out interval of 20 minutes. The primary outcome was the 24 h LA consumption. The secondary outcomes were time of activation of PCRA, pain scores, patient satisfaction scores, and block-related complications. Categorical variables are presented as frequency, while continuous variables are expressed as mean [standard deviation (SD)] or median [interquartile range (IQR)]. An independent t-test or Mann–Whitney U-test was used to compare these continuous variables. A P value less than 0.05 was considered to be statistically significant. Results: Patients in Group CC required less LA 24 h postoperatively (P < 0.001) and more time to activate PCRA (P = 0.003). The mean 24 h LA requirement was 83.35 (SD: 31.92) in Group CC as compared to 121.40 (SD: 48.51) ml in Group LS. They also reported better satisfaction scores (P = 0.001). Pain scores were comparable at all time points. Postoperatively, one patient in Group CC complained of paraesthesia, which subsided on removal of the catheter. Conclusion: Patients receiving post-operative analgesia by the CC catheter require lesser 24 h LA and report better satisfaction than those receiving analgesia through the LS technique.

Background and Aims: The infraclavicular brachial plexus block (ICB) provides analgesia and anaesthesia of the upper limb. It is given using the classical or the more recently described costoclavicular (CC) approach at the level of cords. This systematic review aimed to assess which approach is better for the ICB in terms of onset, performance, and safety. Methods: This PROSPERO (vide registration number CRD42022361636) registered meta-analysis included randomised trials of patients undergoing upper limb surgery in ultrasound-guided ICB from MEDLINE, EMBASE, SCOPUS, and IRCTP from inception to March 2023. The quality of evidence was assessed using GradePro software. The primary outcomes were sensory and motor block onset time and the number of patients having complete block at 30 minutes. Secondary outcomes included block performance time (BPT), number of attempts, duration of the block, and any incidence of complications. Results: Five trials with 374 adult patients (classic = 185, CC = 189) were included. No significant difference was found in the sensory (Mean difference (MD): 1.44 minutes [95% confidence interval (CI): 3.06, 5.95]; I2 = 95%; very low level of evidence (LOE); P = 0.53) and motor block onset times (MD: 0.83 minutes [95% CI: 0.96, 2.62]; I2 = 84%; very low LOE P = 0.36) and BPT (MD: 5.06 seconds [95% CI: 38.50, 48.63]; I2 = 98%; very low LOE; P = 0.82) in classic and CC approach of ICB. Trial sequential analysis revealed our sample size to be 0.65% of the required sample size to achieve 80% power, deeming our study underpowered. Conclusion: Costoclavicular approach was not superior or inferior to the classical technique for infraclavicular brachial plexus block. However, the quality of evidence is low and further studies are needed to corroborate the findings.

Objective: In this study, we evaluated the efficacy and safety of 1 μg/kg dexmedetomidine as an adjuvant treatment to ropivacaine in children undergoing upper limb surgeries under ultrasound-guided axillary brachial plexus blocks and general anesthesia. Methods: We enrolled 90 children (aged 1–8 years; ASA I-II) undergoing closed reduction and internal fixation for upper extremity fractures at the Xiamen Children's Hospital and randomly assigned them to one of two groups: L (injection with 0.25% ropivacaine) or D (injection with 0.25% ropivacaine containing 1 μg/kg dexmedetomidine) using the random number table method. The main outcome indicators recorded were the facial expression, leg activity, position, crying, and Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores of children after surgery and the duration of block and analgesia maintenance. The secondary outcome indicators were vital sign data at the time of ultrasound probe placement (T1), at the time of block completion (T2), prior to the beginning of surgery (T3), 5 min after the beginning of surgery (T4), and at the end of surgery (T5), as well as the time of postoperative recovery, the number of cases of remedial analgesia, and complications. Results: There was no statistical difference between the two groups in terms of general data, block completion time, postoperative recovery time, and complications (P > 0.05). Compared to the L group, the D group had significantly lower FLACC scores at 6 h after surgery, as well as significantly lower systolic blood pressure, diastolic blood pressure, and heart rate values at T4 and T5, and significantly longer duration of postoperative analgesia maintenance (all P < 0.05). Conclusion: Dexmedetomidine (1 μg/kg) as a local anesthetic adjuvant to ropivacaine can alleviate pain at 6 h postoperatively, prolong analgesia maintenance, and reduce intraoperative blood pressure and heart rate in pediatric patients undergoing closed reduction and internal fixation for upper extremity fractures, with no obvious complications or delayed recovery. Clinical registry number: Registration website: www.chictr.org.cn, Registration number: ChiCTR2200065163, Registration date: October, 30, 2022. [ABSTRACT FROM AUTHOR]

Introduction: The need for a standardized core curriculum in regional anesthesia has become essential, particularly with the integration of ultrasound revolutionizing and exponentially increasing clinical practice and possibilities. In fact, numerous novel techniques, often overlapping, can confuse practitioners. This study aims to establish a core curriculum for upper limb, lower limb, paraspinal and fascial plane blocks for residency training, addressing potential educational gaps caused by the multitude of techniques, through a Delphi consensus process involving recognized Italian regional anesthesia experts. Methods: A steering committee was formed in order to select a panel of experts in regional anesthesia. A three-round Delphi consensus was planned: two rounds of electronic voting and a final round of mixed electronic voting and round table discussion. The consensus was defined as ≥ 75% agreement for inclusion and lower than ≤ 25% agreement for exclusion from the core curriculum list. Techniques reaching the 50% threshold were included with low consensus. Results: Twenty-nine techniques were selected to be included in the ultrasound-guided regional anesthesia core curriculum. Twenty-two were included with strong consensus: Upper limb: interscalene brachial plexus block, supraclavicular brachial plexus block, infraclavicular brachial plexus block, axillary brachial plexus block, intermediate cervical plexus block Lower limb: femoral nerve block, pericapsular nerve group block, adductor canal block, sciatic nerve block (transgluteal approach, infragluteal approach, and at the popliteal fossa), ankle block Paraspinal/fascial plane blocks: erector spinae plane block, deep serratus anterior plane block, superficial pectointercostal plane block, interpectoral plane block, pectoserratus plane block, rectus sheath block, ilioinguinal iliohypogastric nerves block, transversus abdominis plane block (with subcostal and midaxillary approaches) The remaining seven techniques were included with low consensus: superficial cervical plexus block, lumbar plexus block, fascia iliaca block (suprainguinal approach), anterior quadratus lumborum block, lateral quadratus lumborum block, paravertebral block, and serratus anterior plane block. Conclusions: This curriculum aims to standardize training and ensure that residents acquire the essential skills required for effective and safe practice regardless of the residents' subsequent specialization. By incorporating these techniques, educational programs can provide a structured and consistent approach to regional anesthesia, enhancing the quality of patient care and improving outcomes. [ABSTRACT FROM AUTHOR]

Background: OFA (Opioid-free anesthesia) has the potential to reduce the occurrence of opioid-related adverse events and enhance postoperative recovery. Our research aimed to investigate whether OFA, combining esketamine and dexmedetomidine, could serve as an alternative protocol to traditional OBA (opioid-based anesthesia) in shoulder arthroscopy, particularly in terms of reducing PONV (postoperative nausea and vomiting). Methods: A total of 60 patients treated with shoulder arthroscopy from September 2021 to September 2022 were recruited. Patients were randomly assigned to the OBA group (n = 30) and OFA group (n = 30), receiving propofol-remifentanil TIVA (total intravenous anesthesia) and esketamine-dexmedetomidine intravenous anesthesia, respectively. Both groups received ultrasound-guided ISBPB(interscalene brachial plexus block)for postoperative analgesia. Results: The incidence of PONV on the first postoperative day in the ward (13.3% vs. 40%, P < 0.05) was significantly lower in the OFA group than in the OBA group. Moreover, the severity of PONV was less severe in the OFA group than in the OBA group in PACU (post-anesthesia care unit) (0 [0, 0] vs. 0 [0, 3], P<0.05) and in the ward 24 h postoperatively (0 [0, 0] vs. 0 [0, 2.25], P<0.05). Additionally, the OFA group experienced a significantly shorter length of stay in the PACU compared to the OBA group (39.4 ± 6.76 min vs. 48.7 ± 7.90 min, P < 0.001). Conclusions: Compared to the OBA with propofol-remifentanil, the OFA with esketamine- dexmedetomidine proved to be feasible for shoulder arthroscopy, resulting in a reduced incidence of PONV and a shorter duration of stay in the PACU. Trial registration: The Chinese Clinical Trial Registry (No: ChiCTR2100047355), 12/06/2021. [ABSTRACT FROM AUTHOR]

Background Regional anesthesia is preferred for lower abdominal surgeries due to its ability to keep patients awake and reduce airway management issues. While 0.5% hyperbaric bupivacaine is commonly used, it does not ensure prolonged postoperative analgesia. Clonidine, an α2 adrenergic agonist, has shown promise in prolonging sensory and motor blockade when used as an adjuvant. This study evaluates the efficacy of intrathecal clonidine as an adjuvant to 0.5% bupivacaine in prolonging analgesia for lower abdominal surgeries. Methods This prospective, randomized controlled study was conducted at MGM Medical College, Navi Mumbai, from November 2021 to September 2023. Sixty patients undergoing elective lower abdominal surgeries were randomly allocated into two groups of 30 each. Group 1 received 3 ml of 0.5% heavy bupivacaine with 30 µg clonidine, while Group 2 received 3 ml of 0.5% heavy bupivacaine with 0.2 ml saline. Onset and duration of sensory and motor blockade, duration of analgesia, hemodynamic parameters, and complications were recorded and analyzed statistically. Results Group 1 showed a significantly quicker onset of analgesia (2.25±0.18 minutes) and motor blockade (8.51±0.175 minutes) compared to Group 2. The duration of motor blockade (220±9.55 minutes) and analgesia (650±9.22 minutes) was significantly longer in Group 1. Hemodynamic parameters remained stable in both groups, but Group 1 experienced a higher incidence of mild postoperative complications such as nausea, sedation, and dry mouth. Conclusion Intrathecal clonidine as an adjuvant to 0.5% bupivacaine significantly prolongs the duration of sensory and motor blockade, as well as postoperative analgesia, making it a valuable addition to regional anesthesia protocols for lower abdominal surgeries. Future studies with larger, multicenter designs and extended follow-up periods are recommended to further validate these findings. [ABSTRACT FROM AUTHOR]

Background: Dexmedetomidine is frequently used as an adjuvant analgesic in both intrathecal and intravenous infusions. Recently, the role of perineural dexmedetomidine has also been addressed. However, existing literature data is scarce concerning the issue. Aim: The present study aimed to assess the efficacy of intravenous Dexmedetomidine sedation to Perineural Dexmedetomidine on Supraclavicular Approach Brachial Plexus Block during upper limb orthopedic surgery. Methods: 80 subjects were randomly divided into two groups of 40 subjects each where Group I subjects were given 1mcg/kg/IV dexmedetomidine as a loading dose for 10 minutes followed by continuous 0.4mcg/kg/hr IV dexmedetomidine infusion and Group II subjects were given 1mcg/kg perineural dexmedetomidine. In both the groups, duration and onset of motor and sensory block, postoperative analgesia need, hemodynamic parameters, and Ramsay sedation scores were assessed along with any encountered side-effect. Results: Mean sensory block onset was significantly higher in Group I with p<0.05, however, mean motor block onset was comparable in two groups with p>0.05. Motor and sensory blockade duration was significantly longer in Group I (p<0.05). Group I subjects showed lower systolic and diastolic blood pressure and lower pulse rate throughout the duration, and SpO2 levels were comparable. No difference in Ramsay sedation score was seen in either group, however, significantly lesser scores were seen at 9, 12, and 15 hours postoperatively in Group I (p<0.05). Mean analgesia rescue time with VAS >4 was higher in Group I significantly (p<0.05). Conclusions: The present study concludes that early sensory block onset was seen in IV dexmedetomidine with significantly longer duration of analgesia, motor, and sensory block in comparison to perineural dexmedetomidine used as an adjuvant to supraclavicular block using 2% of 5mg/kg Lidocaine and 0.5% of 2mg/kg bupivacaine used for upper limb orthopedic surgeries. [ABSTRACT FROM AUTHOR]

Background: Urological operations frequently involve the use of spinal anesthesia. In the present scenario, adding different adjuvants to local anesthetic improve its quality and duration has become common. Aims and Objectives: In patients undergoing elective urological procedures, the purpose of this study was to assess the effects of intrathecal fentanyl or tramadol with 0.5% bupivacaine heavy. Materials and Methods: Patients were divided into two groups of 30 patients each, a total of 60 patients aged 20-60 years undergoing elective urological surgeries participated in this prospective, randomized study in which 25 μg fentanyl and 2.5 mL of 0.5% bupivacaine heavy were given to Group F, while 25 mg tramadol and 2.5 mL of 0.5% bupivacaine heavy were given to Group M. The onset and duration of sensory and motor blockage, the duration of analgesia, post-operative Visual Analog Scale score, hemodynamic changes, and adverse effects were evaluated. Results: Fentanyl had a lower mean time of onset for sensory (2:33±0:22 min vs. 4:50±0:33 min) and motor block (3:36±0:28 min vs. 5:52±0:38 min) (P<0.001), the duration of sensory (185.67±3.155 min vs. 152.60±4.264), motor block (172.00±4.177 min vs. 136.40±5.575 min), and post-operative analgesia was longer in the fentanyl group (P<0.001), whereas the incidence of adverse effects such as pruritus, shivering, and nausea was lower in the tramadol group. Conclusion: The quality and duration of spinal anesthesia were found to be significantly increased by the use of fentanyl as an adjuvant in our study. However, tramadol also produced stable hemodynamics and exhibited fewer adverse effects than fentanyl. [ABSTRACT FROM AUTHOR]

The use of ultrasound in peripheral blocks has now become the gold standard. Ultrasound is a method that is easy to apply and most importantly does not carry any risk, and its only disadvantage is based on the skill and knowledge of the practitioner. Injury to vascular structures, which is the most common occurrence in peripheral block applications, has been significantly reduced by the use of ultrasound. The aim of this study is to determine the location of nerve branches and to determine the most common anthropometric parameters in the axillary fossa. In this way, the common anatomy of the axillary BP will be determined and will guide the practitioners while performing the axillary plexus block. Observational Clinical Study. The patients were positioned with forearm abducted 90 degrees and elbow flexed 90 degrees. A high-frequency linear ultrasound probe was placed on the lateral border of the pectoralis major muscle in the transverse plane. Pulsation of the axillary artery was visualized and shifted slowly to view the nerves around the artery. The axillary vein was also visualized to facilitate the movement of the transducer and to find the nerve localization more easily. The regions on the prepared wheel were marked. At the same time, demographic information such as gender, age, weight, and height of the patients were also recorded. The sample was 248 patients, 61.3% female and 38.7% male. Our results showed that only 59% were compatible with the most common nerve locations in cadaveric dissections and the locations described in anatomy textbooks. Since there are many anatomical variations, validation of nerves with a nerve stimulator as well as simultaneous visual application under ultrasound guidance will increase the success chance of axillary brachial plexus block and protect it from unwanted complications. [ABSTRACT FROM AUTHOR]

Introduction: Compressive neuropathy of the brachial plexus is a common issue following laparoscopic and robotic surgeries. Case Report: A 71-year-old male, post-lumbar spinal surgery, presented with excruciating right upper extremity pain and paresthesias. A supraclavicular brachial plexus (SBP) block with bupivacaine provided significant pain relief, lasting 36 hours. Subsequent physical therapy led to gradual pain and weakness improvement in compressive neuropathy. Discussion: The SBP block, facilitated by ultrasound guidance, is a safe procedure with few serious complications. It proves beneficial for managing postoperative compressive neuropathy, allowing patients to break pain cycles and participate in rehabilitation. Conclusion: The SBP block is an effective addition to the management of postoperative compressive neuropathy, given its ease, safety, and potency. Although regional anesthesia provides only temporary relief, patients can experience a break in debilitating pain cycles associated with compressive neuropathy. [ABSTRACT FROM AUTHOR]

Background: It is aimed to compare the block onset times and performance features of costoclavicular techniques (medial and lateral approach) versus lateral sagittal technique. Methods: Patients were randomized into three groups. For costoclavicular techniques, ultrasound probe was placed parallel to clavicle obtaining nerve cords, axillary artery and axillary vein visual from lateral-to-medial, respectively. The block needle was advanced from lateral (Group CLB) or medial (Group CMB) to perform costoclavicular block. For lateral sagittal technique (Group LSB), ultrasound probe was placed sagittal and perpendicular below the coracoid process to obtain sagittal artery image with the cords around. Total 20 ml of 0.5% bupivacaine and 10 ml of 2% lidocaine were deposited for all groups. Sensory and motor block onset times, block performance properties, complications, and patient/surgeon satisfactions were investigated. Results: Among 56 patients, the primary outcome, sensory block onset time was shorter in Group CLB than Group CMB and Group LSB (10 [5–15], 10 [10–20], and 15 [10–15] minutes, respectively, p < 0.05). Motor block onset was also fastest in Group CLB (15 [10–20] mins for CLB, 20 [15–20] mins for LSB, and 22.5 [15–25] mins for CMB, p = 0.004). Block performance properties did not differ between the groups. The only complication observed was vascular puncture with an incidence of 28% in Group CMB. Conclusions: Lateral approach costoclavicular technique provides fastest block onset than the other techniques. Considering the success and safety profile, this technique stands as a good alternative in clinical practice. Trial registration: This study is prospectively registered to clinicaltrials.gov on 20/02/2022 (NCT05260736). [ABSTRACT FROM AUTHOR]

Objective: To explore the application effect of posterior continuous intermuscular groove brachial plexus block combined with parecoxib sodium preemptive analgesia on patients undergoing shoulder arthroscopic surgery. Methods: 80 patients who underwent shoulder arthroscopic surgery from January 2020 to January 2023 were selected. They were randomly divided into three groups: A, B, and C, with 25 cases in Group A, 25 cases in Group B, and 30 cases in Group C. Group A received routine intravenous anesthesia, Group B received routine intravenous anesthesia combined with posterior continuous intermuscular sulcus brachial plexus block group, and Group C received posterior continuous intermuscular sulcus brachial plexus block combined with parecoxib sodium for preemptive analgesia. Compare the changes in heart rate, blood oxygen, and blood pressure levels, as well as changes in stress response indicators related to cortisol (COR) and norepinephrine (NE), among the three groups of patients at entry (T1), 10 minutes of surgery (T2), 30 minutes of surgery (T3), and immediately after surgery (T4). Compare the incidence of adverse reactions among the three groups of patients. Finally, conduct a 6-month outpatient follow-up for all patients, at preoperative and postoperative 1 month and 3 months, respectively The Constant Murley score was used to evaluate the shoulder joint function of three groups of patients at 6 months. Results: There was no difference in heart rate, blood oxygen saturation, systolic and diastolic blood pressure among the three groups of patients at T1 and T4 time (P>0.05). The heart rate, blood oxygen saturation, systolic and diastolic blood pressure levels of Group C were lower than those of Group A and Group B at T2 and T3 time (P<0.05), and the T1 to T4 time was relatively stable; There was no difference in the expression levels of COR and NE among the three groups of patients at T1 time(P>0.05), while the expression levels of COR and NE were increased in the three groups at T2 and T3 time. Moreover, the expression levels of COR and NE in Group C were lower than those in Group A and Group B at T2, T3, and T4 time(P<0.05); There was no difference in the incidence of adverse reactions among patients in groups A, B and C (P>0.05); There was no difference in the preoperative Constant Murley scores among the three groups of patients. After 1 month, 3 months, and 6 months of surgery, the Constant Murley scores of the three groups of patients all increased, and Group C was significantly higher than Group A and Group B(P<0.05). Conclusion: For patients undergoing shoulder arthroscopic surgery, the combination of posterior continuous intermuscular groove brachial plexus block group and Parexib sodium for preemptive analgesia can stabilize intraoperative blood oxygen saturation, heart rate, and blood pressure levels, reduce intraoperative stress response, and have high safety. At the same time, it can further assist patients in improving long-term shoulder joint function. [ABSTRACT FROM AUTHOR]

Background: The advantages of lower limb orthopedic procedures under spinal anesthetic are quick onset, preservation of spontaneous breathing, relaxation of the required muscles for the procedure, and affordability. It also has the benefit of not carrying the hazards associated with pulmonary aspiration and intubation. Objective: This study aimed to compare the effects of intrathecal versus intravenous dexmedetomidine added to bupivacaine on characteristics of spinal blocks in patients undergoing lower limb orthopedic surgery. Patients and methods: Sixty patients scheduled for lower limb orthopedic surgeries under spinal anesthesia were included in this prospective randomized comparative study. We evaluated the degree of sedation, the onset and duration of sensory and motor block, the quality of intra-operative anesthesia, postoperative analgesia, and adverse effects on patient hemodynamics. Results: Administering dexmedetomidine intravenously or intrathecally shown to be a safe supplement to bupivacaine spinal anesthesia. Intrathecal dexmedetomidine was a better adjuvant. It offered less overall side effects, improved perioperative analgesia, increased augmentation to sensory and motor block, and more stable hemodynamics. During the intraoperative phase, a higher dose of sedation is provided via intravenous dexmedetomidine. In order to validate the outcomes of this work, more research with a greater number of patients is necessary. Conclusion: Administration of dexmedetomidine intravenously or intrathecally shown to be a safe supplement to bupivacaine spinal anesthesia. When comparing intravenous dexmedetomidine to spinal bupivacaine, intrathecal dexmedetomidine was a better adjuvant. [ABSTRACT FROM AUTHOR]

Background and Aims: The infraclavicular brachial plexus block (ICB) provides analgesia and anaesthesia of the upper limb. It is given using the classical or the more recently described costoclavicular (CC) approach at the level of cords. This systematic review aimed to assess which approach is better for the ICB in terms of onset, performance, and safety. Methods: This PROSPERO (vide registration number CRD42022361636) registered meta-analysis included randomised trials of patients undergoing upper limb surgery in ultrasound-guided ICB from MEDLINE, EMBASE, SCOPUS, and IRCTP from inception to March 2023. The quality of evidence was assessed using GradePro software. The primary outcomes were sensory and motor block onset time and the number of patients having complete block at 30 minutes. Secondary outcomes included block performance time (BPT), number of attempts, duration of the block, and any incidence of complications. Results: Five trials with 374 adult patients (classic = 185, CC = 189) were included. No significant difference was found in the sensory (Mean difference (MD): 1.44 minutes [95% confidence interval (CI): 3.06, 5.95]; I2 = 95%; very low level of evidence (LOE); P = 0.53) and motor block onset times (MD: 0.83 minutes [95% CI: 0.96, 2.62]; I2 = 84%; very low LOE P = 0.36) and BPT (MD: 5.06 seconds [ 95% CI: 38.50, 48.63]; I2 = 98%; very low LOE; P = 0.82) in classic and CC approach of ICB. Trial sequential analysis revealed our sample size to be 0.65% of the required sample size to achieve 80% power, deeming our study underpowered. Conclusion: Costoclavicular approach was not superior or inferior to the classical technique for infraclavicular brachial plexus block. However, the quality of evidence is low and further studies are needed to corroborate the findings. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to compare the efficacy of intrathecally administered hyperbaric Ropivacaine 0.75% and hyperbaric Levobupivacaine 0.5% in surgeries of lower limb. Material And Methods: After receiving approval from the Institutional Ethics committee and CTRI registration, 64 patients aged between 18-60 years of age with ASA grade I and II physical status, BMI<30 undergoing elective lower limb surgeries were randomly allocated to one of the two groups of 32 patients each. In Group A, patients were given Hyperbaric Ropivacaine 0.75% 3ml (22.5mg) intrathecally, while in Group B, Hyperbaric Levobupivacaine 0.5 % 3ml (15mg) were given intrathecally. A blinded observer assessed onset and duration of sensory block and motor block, peak height for sensory block, hemodynamic changes and any side effects or complications. Results: Onset of sensory blockade was significantly early in group that received hyperbaric Ropivacaine as compared to the hyperbaric Levobupivacaine, although there was no significant difference in regards to onset of motor blockade amongst both the groups. Duration of sensory as well as motor blockade was found to be prolonged in the group that was administered hyperbaric Levobupivacaine. No remarkable difference amongst the two groups in terms of peak height of sensory block. No significant difference observed in terms of hypotension, bradycardia, shivering or post-op nausea and vomiting. Conclusion: Hyperbaric Ropivacaine can be used for shorter duration, day care surgeries whereas Hyperbaric Levobupivacaine can be used for longer duration surgeries of lower limb. [ABSTRACT FROM AUTHOR]

BACKGROUND Spinal anaesthesia is the most common procedure for lower limb orthopaedic surgeries. Fentanyl, a synthetic opioid and dexmedetomidine, a selective α2 agonist have been used in this study as adjuvants to 0.5% hyperbaric bupivacaine for spinal anaesthesia in lower limb orthopaedic surgeries. AIM The main aim of the study is to compare the efficacy, analgesic effects, hemodynamic stability and side effects of intrathecal fentanyl and dexmedetomidine as adjuvants to 0.5% hyperbaric bupivacaine in lower limb orthopaedic surgeries. MATERIALS AND METHODS 100 patients of ASA class 1 and 2 posted for lower limb orthopaedic surgeries were taken for this study. Patients were randomly allocated using sealed envelopes into 2 groups. Group F - 17.5mg of 0.5% hyperbaric bupivacaine with 25mcg fentanyl intrathecally and group D - 17.5mg of 0.5% hyperbaric bupivacaine with 10 mcg of dexmedetomidine intrathecally. RESULTS In patients who have received dexmedetomidine observed to have significantly longer analgesic effects than the other group who received fentanyl as adjuvant. Mean duration of sensory blockade for group D was 455.54 ± 43.09 mins when compared to Group F which was 283.32 ± 23.994 mins. Post operative shivering was more in Group F patients when compared to Group D patients. CONCLUSION Using dexmedetomidine as an adjuvant to hyperbaric bupivacaine for spinal anaesthesia in lower limb orthopaedic surgeries has longer duration of sensory and motor block and longer postoperative analgesia when compared to intrathecal fentanyl. [ABSTRACT FROM AUTHOR]

Background: Regional nerve blocks are crucial for intraoperative and postoperative pain management, reducing complications linked to general anesthesia. The purpose of this study is to compare the effects of dexamethasone dosages of 2mg & 6mg on sensory & motor block completion periods as well as post-operative analgesic duration in infraclavicular blocks for upper-limb procedures. Methods: Infraclavicular brachial plexus block guided by USG was administered to 34 ASAI and II patients, with 17 patients in each group. 25 ml of 0.5% levobupivacaine and 2 mg dexamethasone were administered to Group A. For the block, Group B received 25 ml of 0.5% levobupivacaine combined with 6 mg dexamethasone. The analysis did not include three of the unsuccessful blocks. After the brachial plexus block, vital parameters were recorded every at 0, 120,150,180, 210 and 240 mins. Postoperatively vitals were recorded at 12 hours, 24 hours and 36 hours. The patient was monitored until the motor and sensory block had regressed completely. Results: The study found that demographic variables and hemodynamic parameters were non-significant in both groups. The mean duration of motor block in group A (2mg) was 1069.38 minutes, significantly lower than group B (6mg) with 1294.07 minutes. Additionally, the mean duration of analgesia in group A (2mg) was 1117.19 minutes, significantly shorter than group B (6mg) with 1418.13 minutes. Conclusion: The study suggests that a 2mg dosage of dexamethasone when combined with 0.5% levobupivacaine, may be a more effective option for infraclavicular brachial plexus blocks due to its ability to provide effective analgesia. [ABSTRACT FROM AUTHOR]

BACKGROUND: The ultrasound guided brachial plexus block is a precise technique of providing anaesthesia & post op analgesia in surgical procedures involving upper limb. This study was conducted to compare two doses of dexmedetomidine given as adjuvant to 0.5% ropivacaine in ultrasound guided brachial plexus block in upper limb surgeries. METHODS : This was a randomised control trial carried out in 60 patients, 18-60 years of age of both sexes posted for upper limb surgeries . Patients were randomly divided into two groups of 30 patients each. Group A received 0.5% Ropivacaine 25 mL plus 30 micrograms dexmedetomedine (0.3 mL) plus 4.7 mL distilled water and Group B received 0.5% Ropivacaine 25 mL plus 50 micrograms (0.5 mL) dexmedetomedine plus 4.5 mL distilled water. Patients were assesed for onset and duration of sensory and motor block, time of rescue analgesia, hemodynamic responses and complications or any side effects. RESULT : Onset of sensory and motor block in Group A was 10.07 ± 0.69 mins and 14.23 ± 0.77 mins respectively while in Group B was 7.47 ± 0.63 mins and 10.0 ± 0.83 mins respectively. Mean duration of sensory block in Group A was 654.40 ± 28.42 mins and in Group B was 942.0 ± 54.32 mins while mean duration of motor block in Group A was 537.03 ± 27.07 mins and Group B was 798.67 ± 67.84 mins. CONCLUSION : We concluded that, 50 micrograms of dexmedetomedine when compared with 30 micrograms of dexmedetomedine with 0.5% ropivacaine produced early onset of both sensory and motor block, longer duration of sensory and motor block and longer postoperative pain relief. [ABSTRACT FROM AUTHOR]

Background There is little literature about the intrathecal use of dexmedetomidine with local anaesthetics in humans. Also, levobupivacaine is known to have lesser CNS and CVS side-effects than its racemic isomer. Fentanyl is a commonly used intrathecal adjuvant. Aims To compare and evaluate the efficacy of levobupivacaine alone, with dexmedetomidine and with fentanyl as adjuvants in spinal anaesthesia for providing adequate analgesia, hemodynamic stability and minimal sedation after infra-umbilical surgeries. Methods A total of 60 patients of ASA I-II of both sexes aged between 20 and 60 years were randomly allocated into three equal groups of 20 patients each. Group L received isobaric levobupivacaine 15 mg with normal saline as control; group LD received levobupivacaine 15 mg with 5 µg dexmedetomidine and group LF received 15 mg of levobupivacaine with 25 mcg of fentanyl, all made up to 4 ml after diluting with normal saline. Results The demographic profiles were comparable among the three groups. Dexmedetomidine showed early appearance of peak sensory level (5.72±1.05) and motor blockade (2.01±0.685), and early reach T10 segments (2.253±0.69). S1 and Bromage 0 regression times were prolonged with dexmedetomidine (225.87±6.65, 194.75±4.17). Analgesic duration was also significantly prolonged with dexmedetomidine (250.33±8.92). Conclusion Adding dexmedetomidine as an adjuvant to levobupivacaine improves the duration of block and analgesia, resulting in early block achievement with minimal side effects. [ABSTRACT FROM AUTHOR]

The utilization of transversus abdominis plane (TAP) block for postoperative pain management has proven to be efficacious. The purpose of this inquiry is to evaluate the effectiveness of right-sided TAP blockade guided by ultrasonography (USG) in managing pain subsequent to laparoscopic cholecystectomy. A total of 60 patients were equallydistributed into two groups. The control group was comprised of patients who did not receive a TAP block, whereas the TAP block group consisted of patients who underwent an ultrasound-guided, right-sided unilateral subcostal TAP block with 20 mL of 0.25% bupivacaine. A Verbal Numerical Rating Scale was administered to all participants for pain assessment at postoperative intervals of 0th, 6th, 12th and 24th hours. Additionally, the overall amount of supplementary analgesic used after surgery, age distribution among each gender classification and body mass index range categories as well as operation time duration; use or non-use of drain; and incidence rate for postoperative complications were recorded for each patient individually. The mean age of participants was 47.72 ± 13.80 years, with a female-to-male ratio of 41/19. The control group exhibited significantly higher pain scale measurements than the block group at the postoperative 0th and the postoperative 24th hour. Drain replacement yielded notably higher pain scores for both TAP and control groups at the postoperative 0th hour. Neither BMI nor operation duration had significant effects on postsurgical pain in either patient group--whether or not they received a TAP block treatment. Our research shows that the implementation of a TAP block and exclusion of surgical area drainage placement yield favorable results in mitigating postoperative pain. Notably, BMI and procedure duration do not exhibit any discernible impact on postoperative pain management. [ABSTRACT FROM AUTHOR]

Background: Peripheral nerve blockade is a crucial component of comprehensive anesthetic care, providing effective analgesia with fewer side effects than opioids and other oral analgesics. Aims and Objectives: This study investigated the effectiveness of a magnesium adjuvant in an ultrasound-guided supraclavicular brachial plexus block to determine the minimum dose required for the desired effects. Materials and Methods: This prospective, double-blind, and randomized controlled study included 90 patients scheduled for elective upper limb orthosurgery at GTMCH. The 90 patients were divided into three groups: A, B, and C. Each group received 21.5 mL of the test drug, with A receiving ropivacaine and normal saline, B receiving ropivacaine and magnesium, and C receiving ropivacaine and magnesium. Results: There was a significant difference in Group A between the onset of sensory and motor blockade in Groups B and C. There was a significant difference in Group A between the duration of sensory and motor blockade in Groups B and C, but no significant difference was observed between Groups B and C. The visual analog scale score varied from 0 to 6 in Group A and from 0 to 5 in Groups B and C. It was found to be significant only from the 7th to 10th h. There was a significant difference in Group A between Groups B and C in 1st rescue analgesia post-operatively and the number of rescue injections in the first 24 h, but no significant differences was observed between Groups B and C. Conclusion: Both 100 and 150 mg magnesium sulfate with 0.5% ropivacaine in supraclavicular blocks prolonged the blockade duration and reduced analgesic needs. [ABSTRACT FROM AUTHOR]

Background: In supraclavicular brachial plexus block, to prolong the duration of analgesia, many adjuvants have been tried in the past in many studies but an ideal adjuvant remains yet to be discovered. Dexmedetomidine, a selective Alfa-2 adrenergic agonist when added to local anesthetic has been reported to prolong the block duration and post-operative analgesia in various regional blocks. Aims and Objectives: The aims and objectives are to study the onset and duration of sensory and motor blockade, postoperative analgesia, and hemodynamic effects of addition of dexmedetomidine with ropivacaine in supraclavicular brachial plexus block. Materials and Methods: Sixty patients aged between 18 and 60 years, American Society of Anesthesiologists class I and II, of both sexes, scheduled for upper limb surgery under supraclavicular brachial plexus block were randomly allocated into 2 groups. Group-A received 20 mL of 0.5% ropivacaine in brachial plexus block with 1 µg/kg dexmedetomidine as adjuvant perineurally and Group-B received 20 mL 0.5% ropivacaine in brachial plexus block with dexmedetomidine intravenous infusion at 1 µg/kg over 10 min. Intraoperatively non-invasive blood pressure, heart rate, SpO2, and sedation were recorded every 5 min for the first 10 min and every 15 min thereafter till the end. Time of first rescue analgesic, intensity of postoperative pain, and total analgesic required were recorded. Results: Onset of sensory and motor block was faster in Group-A than Group-B. Duration of analgesia was prolonged in Group-A than Group-B. Hemodynamic stability was better maintained in Group-A than Group-B. Sedation was better in Group B. Conclusion: Dexmedetomidine as adjuvant to ropivacaine in supraclavicular brachial plexus block is more efficacious in providing faster onset of motor and sensory blocks and prolonging duration of postoperative analgesia with better hemodynamic stability. [ABSTRACT FROM AUTHOR]

Hip replacement surgery can be painful; postoperative analgesia is crucial for comfort and to facilitate recovery. Regional anaesthesia can reduce pain and postoperative opioid requirements. The role of ultrasound-guided suprainguinal fascia iliaca block for analgesia after elective total hip arthroplasty is not well defined. This randomised trial evaluated its analgesic efficacy. Consenting participants (134) scheduled for elective primary total hip arthroplasty under spinal anaesthesia were randomly allocated to receive ultrasound-guided fascia iliaca block with ropivacaine 0.5% or sham block with saline. The primary outcome was opioid consumption in the first 24 h after surgery. Additional outcomes included pain scores at 4, 8, 12, and 16 h, opioid-related side-effects (nausea, vomiting, pruritis), ability to perform physiotherapy on the first postoperative day, and physiotherapist-assessed quadriceps weakness. There were no significant differences in 24-h opioid consumption (block vs sham block, mean difference −3.2 mg oral morphine equivalent, 95% confidence interval −15.3 to 8.1 mg oral morphine equivalent, P =0.55) or any other prespecified outcomes. In patients undergoing primary total hip arthroplasty, ultrasound-guided suprainguinal fascia iliaca block with ropivacaine did not confer a significant opioid-sparing effect compared with sham block. There were no differences in other secondary outcomes including pain scores, opioid-related side-effects, or ability to perform physiotherapy on the first postoperative day. www.clinicaltrials.gov (NCT03069183). [ABSTRACT FROM AUTHOR]

The efficacy of perineural vs intravenous dexamethasone as a local anaesthetic adjunct to increase duration of analgesia could be particular to specific peripheral nerve blocks because of differences in systemic absorption depending on the injection site. Given this uncertainty, we performed a systematic review with meta-analysis and trial sequential analysis comparing dexamethasone administered perineurally or intravenously combined with local anaesthetic for interscalene brachial plexus block. Following a search of various electronic databases, we included 11 trials (1145 patients). The primary outcome was the duration of analgesia defined as the time between peripheral nerve block or onset of sensory blockade and the time to first analgesic request or initial report of pain. The primary outcome, duration of analgesia, was greater in the perineural dexamethasone group, with a mean difference (95% confidence interval) of 122 (62–183) min, I 2=73%, P <0.0001. Trial sequential analysis indicated that firm evidence had been reached. The quality of evidence was downgraded to low, mainly because of moderate inconsistency and serious publication bias. No significant differences were present for any of the secondary outcomes, except for onset time of sensory and motor blockade and resting pain score at 12 h, but the magnitude of differences was not clinically relevant. There is low-quality evidence that perineural administration of dexamethasone as a local anaesthetic adjunct increases duration of analgesia by an average of 2 h compared with intravenous injection for interscalene brachial plexus block. Given the limited clinical relevance of this difference, the off-label use of perineural administration, and the risk of drug crystallisation, we recommend intravenous dexamethasone administration. PROSPERO (CRD42023466147). [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Several regional anesthesia (RA) techniques have been described for distal upper limb surgery. However, the best approach in terms of RA block success rate and safety is not well recognized. Objective: To assess and compare the surgical anesthesia and efficacy of axillary brachial plexus block with other RA techniques for hand and wrist surgery. The attainment of adequate surgical anesthesia 30 min after block placement was considered a primary outcome measure. Additionally, successful block outcomes were required without the use of supplemental local anesthetic injection, systemic opioid analgesia, or the need to convert to general anesthesia. Methods: We performed a systematic search in the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and CENTRAL. RCTs comparing axillary blocks with other brachial plexus block techniques, distal peripheral forearm nerve block, intravenous RA, and the wide-awake local anesthesia no tourniquet (WALANT) technique were included. Results: In total, 3070 records were reviewed, of which 28 met the inclusion criteria. The meta-analysis of adequate surgical anesthesia showed no significant difference between ultrasound-guided axillary block and supraclavicular block (RR: 0.94 [0.89, 1.00]; p = 0.06; I2 = 60.00%), but a statistically significant difference between ultrasound-guided axillary block and infraclavicular block (RR: 0.92 [0.88, 0.97]; p < 0.01; I2 = 53.00%). Ultrasound-guided infraclavicular blocks were performed faster than ultrasound-guided axillary blocks (SMD: 0.74 [0.30, 1.17]; p < 0.001; I2 = 85.00%). No differences in performance time between ultrasound-guided axillary and supraclavicular blocks were demonstrated. Additionally, adequate surgical anesthesia onset time was not significantly different between ultrasound-guided block approaches: ultrasound-guided axillary blocks versus ultrasound-guided supraclavicular blocks (SMD: 0.52 [−0.14, 1.17]; p = 0.12; I2 = 86.00%); ultrasound-guided axillary blocks versus ultrasound-guided infraclavicular blocks (SMD: 0.21 [−0.49, 0.91]; p = 0.55; I2 = 92.00%). Conclusions: The RA choice should be individualized depending on the patient, procedure, and operator-specific parameters. Compared to ultrasound-guided supraclavicular and infraclavicular block, ultrasound-guided axillary block may be preferred for patients with significant concerns of block-related side effects/complications. High heterogeneity between studies shows the need for more robust RCTs. [ABSTRACT FROM AUTHOR]

Background: In recent years, the suprainguinal fascia iliaca compartment block (SFICB) has become more common in clinical practice. This assessor-blinded dose-finding study aimed to determine the minimum effective concentration (MEC90, MEC95) of bupivacaine for a single-injection SFICB in patients undergoing arthroscopic anterior cruciate ligament repair. Methods: This prospective study was conducted at a tertiary hospital (postoperative recovery room and ward). The SFICB was performed as a postsurgical intervention after spinal anesthesia. Seventy patients were allocated using the biased-coin design up-and-down sequential method. The ultrasound-guided SFICB was performed using different bupivacaine concentrations, and standard multimodal analgesia was administered to all patients. Block success was defined as the absence of pain or presence of only tactile sensation during the pinprick test conducted on the anterior and lateral regions of the midthigh six hours postoperatively. Results: According to isotonic regression and bootstrap CIs, the MEC90 value of bupivacaine for a successful SFICB was 0.123% (95% CI [0.098, 0.191]) and the MEC95 value was 0.188% (95% CI [0.113, 0.223]). Conclusions: Our study showed that the MEC90 and MEC95 values for bupivacaine administered via an SFICB for analgesia were 0.123% and 0.188%, respectively. One advantage of using lower concentrations of bupivacaine is the associated reduction in quadriceps weakness. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the anesthetic efficacy of various concentrations of ropivacaine in ultrasound-guided brachial plexus block surgery in the inter-costoclavicular space. Methods: 94 patients for brachial plexus block surgery identified from March 2021 to March 2023 in Jilin Province, China were selected as the study subjects; they were divided into control group and study group, and the control group received 0.3% ropivacaine 20 ml while the study group received 20 ml of 0.4% ropivacaine. The nerve block efficiency, secondary evaluation index, VAS scores at 12 h, 24 h and 48 h after surgery and the occurrence of adverse reactions were determined. Results: There was no notable difference in the success rate of nerve block between the control and study group (91.49 % vs 95.74 %, χ² = 0.712, p = 0.399). In comparison to control, the study group exhibited no noteworthy variance in the commencement time of the sensory block, whereas the remaining three indicators were significantly shortened (p < 0.05). The VAS scores at 12 and 24 h after surgery were markedly lower compared to the control (p < 0.05), while at 48 h, VAS scores were slightly lower (p > 0.05). There was no significant disparity in the overall incidence of adverse reactions between the two groups (4.26 vs. 6.38 %), neither were there serious complications such as tube nerve injury, local anesthetic poisoning, Horner's syndrome, pneumothorax, and postoperative sensory-motor abnormalities (p < 0.05). Conclusion: Using 0.4 % ropivacaine in ultrasound-guided intercostal brachial plexus block surgery achieves a higher success rate, enhances nerve block onset and duration, and improves postoperative pain relief, all without raising the incidence of adverse reactions, when compared to the use of 0.3 % ropivacaine concentration. However, larger clinical trials are required before the application of this strategy in clinical practice. [ABSTRACT FROM AUTHOR]

Background and Aim: There is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries. Methods: A double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications. Results: Demographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications. Conclusion: Sequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration. [ABSTRACT FROM AUTHOR]

Background: The costoclavicular space serves as an alternative approach to the infraclavicular brachial plexus block, and numerous studies in adults have demonstrated promising outcomes for distal upper limb surgery. Blocking the brachial plexus at this level is potentially advantageous because the cords are relatively superficial, located in close proximity to each other and easily identified using ultrasound. Aims: This study aimed to assess the success rate and feasibility of costoclavicular block in children undergoing unilateral below elbow upper limb surgery. Methods: Thirty children aged 2–12 years scheduled for unilateral below elbow surgery under general anesthesia were included. Costoclavicular block was performed under ultrasound and nerve stimulator guidance with 0.5% ropivacaine, 0.5 mL/kg. Success was evaluated based on the absence of significant hemodynamic response to skin incision made 20 min after the block. The sono‐anatomy of costoclavicular space, ease of needling, complications, and the post‐operative pain scores were assessed. Results: The mean age and weight of the children were 6.5 ± 3.8 years and 19.7 ± 9.1 kg, respectively. The success rate of costoclavicular block in our cohort is 100%. Sonographic visualization was graded as excellent (Likert Scale 2) in 90% of cases. The plexus was located at a depth of 1.4 ± 0.3 cm from the skin, the lateral extent of cords from the artery was 0.8 ± 0.4 cm and they were observed inferior and lateral to the artery. The mean needling time was 3.6 ± 1.1 min. None of the children experienced complications such as vascular or pleural puncture, hematoma, Horner's syndrome or diaphragmatic palsy. Postoperative pain scores were low, and no rescue analgesia was required. Conclusions: In conclusion, the costoclavicular block exhibited a notably high success rate in pediatric population. This study substantiates that the three cords of the brachial plexus are consistently visible and superficial during ultrasound examination using this approach, confirming their separation from vascular structures and the reliable achievement of blockade without observed complications. [ABSTRACT FROM AUTHOR]

In this retrospective study, we identified patients who had undergone outpatient, arthroscopic shoulder surgery utilizing interscalene nerve block, and compared them to those who underwent general anesthesia with multimodal analgesia. We hypothesized that PACU discharge time would be significantly lower, and that pain control would be superior, for patients undergoing ISB with sedation as compared to general anesthesia with MMA. 64 cases were evaluated. The duration of time spent in PACU was significantly lower in the ISB group, while pain scores were both clinically and statistically significantly lower in the ISB group, and opioid requirements were also significantly lower. Peripheral nerve blockade remains superior to MMA for minimizing recovery time, and control of postoperative pain. [ABSTRACT FROM AUTHOR]

Regional anaesthesia in children is a growing field of interest in current anaesthesia practice. We report a case of brachial plexus block for a child with severe forearm necrotizing fasciitis and septicaemia. The need to avoid the multiple shortcomings of general anaesthesia in a critically ill child prompted the use of regional anaesthesia. This case is reported to highlight the prospect of regional anaesthesia for critically ill children who require surgical interventions in resource- poor settings.

Background and Aim: There is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries. Methods: A double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications. Results: Demographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications. Conclusion: Sequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration.

Background: Ultrasound (US)-guided costoclavicular block (CCB) is a promising new approach to brachial plexus (BP) block which is increasingly being utilized. Conventionally, the costoclavicular space (CCS) has been described to contain three cords. However, there may be variations in the neural pattern of the BP which is important to know to prevent inadvertent injury. We intend to describe the variations in neural patterns from retrospective scans of patients receiving costoclavicular BP block. Methods: The stored US images of patients who had received BP block using the CCB for surgery at the level of the elbow or below in the last year (from March 2021 to March 2022) were analyzed by two investigators independently. The clinical data were retrieved from the records of the same patients for the study outcomes. We collated the variations of the neural pattern, the number of neural structures seen, and the echogenicity of the structures in the costoclavicular BP space. Results: In the CCS, the median number of neural structures was 4.5 (minimum of 3 to maximum of 8). With the BP lateral to the axillary artery and sandwiched between the subclavius-pectoralis minor superiorly and the serratus anteriorly inferiorly, numerous variations in the neural structures were noted. The most common arrangement was caterpillar-like (28.6%) and pecker-like (20.3%). The neural structures were found to be hypoechoic in the majority (66%). Conclusion: The CCS hosts several mostly hypoechoic neural structures which may be the variations of the cords or the extension of BP divisions. These new findings have been unreported in the recent past.

Introduction: Apart from general anaesthesia, brachial plexus block by the axillary approach is one of the reliable sole anaesthetic techniques for patients undergoing upper limb surgeries. In this study, levobupivacaine was chosen due to fewer adverse effects compared to Bupivacaine, and fewer studies were available for the axillary approach to brachial plexus block. Adjuvants were added to hasten the onset and also to prolong their analgesic effect. Aim: To compare the effect of Dexmedetomidine (D) 0.5 mcg/kg and Fentanyl (F) 0.5 mcg/kg when added to 0.5% Levobupivacaine (L) as an adjuvant in brachial plexus block by the axillary approach for upper limb surgeries. Materials and Methods: A randomised double-blind controlled study was carried out at the Department of Anaesthesiology, Sree Balaji Medical College, BIHER, Chennai, Tamil Nadu, India from January 2020 to October 2021 on 60 American Society of Anaesthesiologists (ASA) I and II patients of either sex posted for various types of upper limb surgeries. Subjects were divided into two equal groups by computer-generated randomisation. Group A received 0.5% levobupivacaine and dexmedetomidine 0.5 mcg/kg, and Group B received 0.5% levobupivacaine and Fentanyl 0.5 mcg/kg. Both patients and the evaluator were unaware of the type of adjuvants added to the local anaesthetic. The onset time, duration of sensory and Motor blockade were recorded. Haemodynamic variables and duration of analgesia were recorded for 24 hours postoperatively. The Mann-Whitney U test demonstrated variations in the onset and duration of sensory and motor blocks. Adverse effects, including nausea, vomiting, and hypotension, exhibited significant differences according to Fisher’s-exact test. Results: Age and weight distributions were comparable between groups (mean age: Group A=45.20 years, Group B=44.80 years; mean weight: Group A=74.13 kg, Group B=74.43 kg). Group A exhibited faster sensory and motor block onset times (sensory: Group A=6.20 minutes, Group B=8.63 minutes; motor: Group A=8.27 minutes, Group B=10.00 minutes), longer block durations (sensory: Group A=11.63 hours, Group B=9.53 hours; motor: Group A=9.67 hours, Group B=8.20 hours), and required the first rescue analgesic (Group A=12.57 hours, Group B=10.27 hours) compared to Group B (p

Yuecheng Yang,1,2 Yunkui Zhang,1,2 Jun Zhang1,2 1Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; 2Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People’s Republic of ChinaCorrespondence: Jun Zhang, Department of Anesthesiology, Fudan University Shanghai Cancer Center, Dong-An Road No. 270, Shanghai, People’s Republic of China, Tel +86 021-64175590, Fax +86 021-6417477, Email snapzhang@aliyun.com

Usman Maqsood,1 Abdur Rehman,2 Saba Shafiq2 1Acute Medicine Department, Royal Stoke University Hospital, University Hospitals North Midlands, NHS Trust, Stoke-on-Trent, UK; 2Rawalpindi Medical University, Rawalpindi, Punjab, PakistanCorrespondence: Abdur Rehman, Rawalpindi Medical University, Tipu Road, Chamanzar Colony, Rawalpindi, Punjab, Pakistan, Tel +923340509801, Email dr.malik.ar123@gmail.com