Case series: ultrasound-guided supraclavicular block using a curvilinear probe in 104 day-case hand surgery patients

Tsui, Ban C. H.; Doyle, Kathleen; Chu, Kinny; Pillay, Jennifer; Dillane, Derek

doi:10.1007/s12630-008-9006-5

Cited by 30 publications

(22 citation statements)

References 24 publications

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“…53 In the interim, the International Registry of Regional Anesthesia reported 1 pneumothorax in 2384 US-guided supraclavicular blocks (point estimate, 0.4:1000; 95% CI, 0.01-2.3:1000). 63 This point estimate is comparable to an estimated 1:1000 upper 95% CI that results from combining "zero incidence data" from our 2010 report with 2 subsequent registries 46,50 and a small case series, 62 giving a total of 2839 blocks. In addition to supraclavicular block data, no pneumothorax was identified during an observational study of 627 US-guided infraclavicular blocks.…”

Section: Hemidiaphragmatic Paresissupporting

confidence: 62%

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Ultrasound-Guided Regional Anesthesia and Patient Safety

Neal¹

2016

Regional Anesthesia and Pain Medicine

230

103

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Since the original 2010 publication of this analysis, evidence has continued to support the concept that ultrasound (US) guidance does not meaningfully affect the incidence of peripheral nerve injury (PNI) associated with regional anesthesia. Similar confirmatory evidence attests to US guidance reducing the incidence and intensity of hemidiaphragmatic paresis (HDP) but not eliminating it. Literature published since late 2009 reports the effective role of US guidance in reducing the incidence of local anesthetic systemic toxicity and allows calculation of a lower predicted frequency of pneumothorax associated with US-guided supraclavicular blocks.

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Section: Hemidiaphragmatic Paresissupporting

confidence: 62%

“…The median Jadad score for these studies was 3.5. Absence of pneumothorax was mentioned in 7 studies of supraclavicular block(3 new since 2009)34,39,46,49,50,57,62 and 1 new study of infraclavicular block 45 that together amassed 3466 patients. A large registry reported 1 pneumothorax in 2384 supraclavicular blocks.…”

mentioning

confidence: 99%

Ultrasound-Guided Regional Anesthesia and Patient Safety

Neal¹

2016

Regional Anesthesia and Pain Medicine

230

103

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“…In a review of 104 patients scheduled for hand surgeries using ultrasound and nerve stimulation by Tsui et al, surgical regional anaesthesia was achieved in 94.2 % of the cases with an onset time of 20.2 +/-9.2 min [17].…”

Section: Ultrasound Versus Ultrasound Plus Nerve Stimulation Techniquementioning

confidence: 99%

Ultrasound guided supraclavicular block

et al. 2013

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“…13 Upon placement of the tip of the needle (Pajunk 22G insulated) at the site of the brachial plexus, impedance was recorded before and after an injection of D5W 3 mL. To serve as a control and to assess the impedance changes over the clinical course of the block procedure, attempts were made to record impedance values in patients during (30 sec) the bolus injection of local anesthetic solution, which consisted of 1.5% lidocaine and 0.125% bupivacaine.…”

Section: Perineural Impedance Measurementsmentioning

confidence: 99%

No change in impedance upon intravascular injection of D5W

Chin

Tsui

2010

Can J Anesth/J Can Anesth

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Purpose Electrical impedance increases following test injections of non-conducting solutions around nerves; however, this increase should diminish rapidly with intravascular needle placement, wherein the systemic circulation will dissipate the solution. For this observational study, we hypothesized that the impedance increases significantly at the perineural space after an injection of 5% dextrose in water (D5W), but that it does not increase correspondingly at the intravascular location Methods After Ethics Research Board approval, electrical impedance was measured by a nerve stimulator displaying resistance, StimuplexÒ HNS 12, before and during (30 sec) an injection of D5W 3 mL: 1) during intravenous cannula placement using an insulated stimulating needle sheathed in its plastic cannula, MultiSet NanoLine with 18G needle; and 2) during needle placement (Pajunk 22G insulated) for an ultrasound-guided supraclavicular block in patients undergoing hand surgery. The impedance changes at each location were analyzed and compared. Results Data were collected from 16 patients. Baseline impedance was lower intravascularly (mean 16.5 ± standard deviation 7.2 kX) compared with perineurally (23.5 ± 8.3 kX) (P = 0.037). Peak impedance after intravascular D5W injection was 20.1 ± 6.8 kX, which was not a significant change (P = 0.15). In contrast, peak impedance after perineural D5W injection was 58.6 ± 29.1 kX, an increase of 35.1 ± 26.4 kX (155 ± 117%), and then it reached a plateau of 36.7 ± 19.6 kX. The increase in impedance was significantly greater at the perineural location (P \ 0.0001). Conclusion The absence of a significant increase in impedance upon injection of D5W prior to injection of local anesthetic may provide useful information to warn of intravascular injection. RésuméObjectif L'impe´dance e´lectrique augmente apre`s les injections de test de solutions non conductrices autour des nerfs; toutefois, cette augmentation devrait diminuer rapidement lors d'un positionnement intravasculaire de l'aiguille, situation dans laquelle la circulation syste´mique dissipera la solution. Pour re´aliser cette e´tude observationnelle, nous avons e´mis l'hypothe`se que l'impe´dance augmentait de façon significative dans l'espace pe´rineural apre`s une injection de dextrose a`5 % dilue´e dans de l'eau (D5W), mais qu'elle n'augmentait pas de la meˆme manie`re dans un site intravasculaire. Méthode Apre`s avoir reçu l'approbation du Comited 'e´thique de la recherche, l'impe´dance e´lectrique a e´teḿ esure´e à l'aide d'un stimulateur nerveux affichant la re´sistance, le StimuplexÒ HNS 12, avant et pendant (30 sec) une injection de 3 mL de D5W: 1) pendant le positionnement d'une canule intraveineuse a`l'aide d'une aiguille de stimulation isole´e prote´ge´e par sa canule de plastique, le MultiSet NanoLine avec une aiguille 18G; et 2) pendant le positionnement de l'aiguille (Pajunk 22G isole´e) pour un bloc supraclaviculaire par e´choguidage chez des patients subissant une chirurgie de la main. Les changements d'impe´dance a`c...

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Case series: ultrasound-guided supraclavicular block using a curvilinear probe in 104 day-case hand surgery patients

Cited by 30 publications

References 24 publications

Ultrasound-Guided Regional Anesthesia and Patient Safety

Ultrasound-Guided Regional Anesthesia and Patient Safety

Ultrasound guided supraclavicular block

No change in impedance upon intravascular injection of D5W

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