Continuous Peripheral Nerve Blocks in Hospital Wards after Orthopedic Surgery

Capdevila, Xavier; Pirat, Philippe; Bringuier, Sophie; Gaertner, Élisabeth; Singelyn, François; Bernard, Nathalie; Choquet, Olivier; Bouaziz, Hervé; Bonnet, Francis

doi:10.1097/00000542-200511000-00018

Cited by 449 publications

(122 citation statements)

References 46 publications

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“…However, there are relatively fewer reports of injury to lower extremity nerves in anesthetized or heavily sedated patients. 54 Whether this variation in reported injury is a function of relative block frequency, practice patterns, or reflects an inherent difference in risk is unknown. Finally, data are limited with regards to the risk, if any, of performing peripheral nerve blocks in the setting of an incomplete proximal peripheral nerve or plexus block, or an unresolved neuraxial block.…”

Section: Regional Anesthesia In Anesthetized or Heavily Sedated Patientsmentioning

confidence: 99%

ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

Neal¹,

Bernards²,

Hadžić³

et al. 2008

Regional Anesthesia and Pain Medicine

238

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Neurologic complications associated with regional anesthesia and pain medicine practice are extremely rare. The ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine addresses the etiology, differential diagnosis, prevention, and treatment of these complications. This Advisory does not focus on hemorrhagic and infectious complications, because they have been addressed by other recent ASRA Practice Advisories. The current Practice Advisory offers recommendations to aid in the understanding and potential limitation of neurologic complications that may arise during the practice of regional anesthesia and pain medicine. KeywordsComplications of anesthesia; Nerve injury; Spinal anesthesia; Epidural anesthesia; Peripheral nerve block; Regional anesthesia; Pain medicine; Transforaminal block The American Society of Regional Anesthesia and Pain Medicine (ASRA) convened a group of experts to develop a Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine. The goal of this Practice Advisory is to provide information for practitioners of regional anesthesia and pain medicine regarding the etiology, differential diagnosis, prevention, and treatment of neurologic complications. This Practice Advisory focuses on neurologic injuries apart from those caused by hemorrhagic 1 or infectious2 -6 complications, both of which have been the subject of other recent ASRA-sponsored Practice Advisories. The current report is a summation of the Practice Advisory's findings and recommendations. Anesthesiologists are strongly encouraged to read the manuscripts that accompany the present summary document, because they contain the details upon which recommendations are based. The accompanying manuscripts represent most of the subtopics discussed at the conference. The recommendations contained within this Practice Advisory represent the opinions of a small group of expert panelists and are based upon their clinical experience, review of limited scientific literature (anatomic and physiologic studies of animals and human cadavers, case reports, retrospective case series, and non-randomized trials), and open forum discussion. Importantly, in this imperfect setting of controversial topics, limited data, and bias inherent to expert opinion, the Panel consistently tended towards making conservative recommendations. We acknowledge that other experts analyzing the same information may arrive at recommendations different than ours. The recommendations contained herein are not intended to define standard practice or to ensure the avoidance of adverse outcomes. Furthermore, the recommendations are subject to change as new information becomes available. Recommendations from the Practice Advisory are not intended to replace clinical judgment, and specific risk-to-benefit discussions as they pertain to individual patients.Because neurologic injuries related to anesthesia and pain medicine practice are extremely rare, standard tools of evidence-based medicine such as randomized c...

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Section: Regional Anesthesia In Anesthetized or Heavily Sedated Patientsmentioning

confidence: 99%

ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

Neal¹,

Bernards²,

Hadžić³

et al. 2008

Regional Anesthesia and Pain Medicine

238

View full text Add to dashboard Cite

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“…However, epidemiological studies demonstrate that high dosage and long duration of exposure of LAs could provoke potential neuronal toxicity, as manifested by transient neurologic syndrome, cauda equina syndrome and delayed sacral nerve disorder 1, 2, 3, 4, 5, 6. Most damages are transient and often subclinical or present as mild mononeuropathies, however, major complications could be also resulted from permanent neuron damage 1, 2.…”

Section: Introductionmentioning

confidence: 99%

Autophagy activated by tuberin/mTOR/p70S6K suppression is a protective mechanism against local anaesthetics neurotoxicity

Xiong

Kong

Dai

et al. 2016

J Cellular Molecular Medi

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The local anaesthetics (LAs) are widely used for peripheral nerve blocks, epidural anaesthesia, spinal anaesthesia and pain management. However, exposure to LAs for long duration or at high dosage can provoke potential neuronal damages. Autophagy is an intracellular bulk degradation process for proteins and organelles. However, both the effects of LAs on autophagy in neuronal cells and the effects of autophagy on LAs neurotoxicity are not clear. To answer these questions, both lipid LAs (procaine and tetracaine) and amide LAs (bupivacaine, lidocaine and ropivacaine) were administrated to human neuroblastoma SH‐SY5Y cells. Neurotoxicity was evaluated by MTT assay, morphological alterations and median death dosage. Autophagic flux was estimated by autolysosome formation (dual fluorescence LC3 assay), LC3‐II generation and p62 protein degradation (immunoblotting). Signalling alterations were examined by immunoblotting analysis. Inhibition of autophagy was achieved by transfection with beclin‐1 siRNA. We observed that LAs decreased cell viability in a dose‐dependent manner. The neurotoxicity of LAs was tetracaine > bupivacaine > ropivacaine > procaine > lidocaine. LAs increased autophagic flux, as reflected by increases in autolysosome formation and LC3‐II generation, and decrease in p62 levels. Moreover, LAs inhibited tuberin/mTOR/p70S6K signalling, a negative regulator of autophagy activation. Most importantly, autophagy inhibition by beclin‐1 knockdown exacerbated the LAs‐provoked cell damage. Our data suggest that autophagic flux was up‐regulated by LAs through inhibition of tuberin/mTOR/p70S6K signalling, and autophagy activation served as a protective mechanism against LAs neurotoxicity. Therefore, autophagy manipulation could be an alternative therapeutic intervention to prevent LAs‐induced neuronal damage.

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“…Given the absence of these reports, the obvious trauma exerted onto the catheter in our case and a tourniquet time of only 20 minutes, it is unlikely that the use of a tourniquet has played a role in the pathogenesis of the femoral nerve injury in our case. Time to neurologic recovery of a femoral nerve lesion ranges from 36 hours to 6 months (Feibel et al, 2009, Capdevila et al, 2005. In our case, at 7-month follow-up, clinical weakness of the quadriceps muscle persisted, but EMG showed evidence of reinnervation (fasciculation potentials).…”

Section: Discussionmentioning

confidence: 57%

Compartment Syndrome, Femoral Nerve Lesion and Recurrent Haemarthrosis in one and the same Patient after Total Knee Arthroplasty

Boonen¹,

Kerens²,

Schotanus³

et al. 2013

IJCRM

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We present a case of a 53 year old patient that underwent total knee arthroplasty in our hospital for degenerative arthritis and developed a series of very uncommon complications. Compartment syndrome of the calf occurred postoperatively as a result of bleeding from a large, ruptured knee joint cyst. Femoral nerve lesion was diagnosed and was most likely the result of traumatic migration of the femoral nerve catheter in the nerve sheet. Finally, our patient suffered from recurrent haemarthrosis in which anticoagulant therapy is thought to have played a key role.This series of very uncommon complications occurring in one and the same patient stresses the importance for orthopaedic surgeons to continuously and carefully monitor their patients postoperatively in order to adequately diagnose complications, also the rare ones, and to take appropriate measurements to minimize dramatic outcomes of these complications.

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Continuous Peripheral Nerve Blocks in Hospital Wards after Orthopedic Surgery

Abstract: CPNB is an effective technique for postoperative analgesia. Minor incidents and bacterial colonization of catheters are frequent, with no adverse clinical consequences in the large majority of cases. Major neurologic and infectious adverse events are rare.

Cited by 449 publications

References 46 publications

ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

Autophagy activated by tuberin/mTOR/p70S6K suppression is a protective mechanism against local anaesthetics neurotoxicity

Compartment Syndrome, Femoral Nerve Lesion and Recurrent Haemarthrosis in one and the same Patient after Total Knee Arthroplasty

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