Does Local Anesthetic Dilution Influence the Clinical Effectiveness of Multiple-Injection Axillary Brachial Plexus Block?

Bertini, Laura; Palmisani, Stefano; Mancini, Stefania; Martini, Ornella; Ioculano, Rossana; Arcioni, R.

doi:10.1097/aap.0b013e3181ae72b6

Cited by 21 publications

(12 citation statements)

References 17 publications

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“…Nevertheless, lower concentrations might be less efficacious and the minimum concentration at which procaine would still provide sensory block is, to date, unknown. Moreover, the role that the volume:concentration ratio has on block success rate, onset time and duration remains controversial in the literature (Taboada Muñiz et al 2008;Bertini et al 2009;Cappelleri et al 2014).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided lateral and subcostal transversus abdominis plane block in calves: a cadaveric study

Mirra

Rotz

Schmidhalter

et al. 2018

Veterinary Anaesthesia and Analgesia

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TAP injections were easy to perform with both techniques in calf cadavers. The volume of injectate did not influence spread. The authors conclude that a combination of the two approaches is necessary, but perhaps not sufficient, to stain all of the nerves innervating the ventral abdominal wall. Further studies are required to refine the technique and evaluate its efficacy in preventing nociception in calves.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-guided lateral and subcostal transversus abdominis plane block in calves: a cadaveric study

Mirra

Rotz

Schmidhalter

et al. 2018

Veterinary Anaesthesia and Analgesia

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“…61,147 The timing of the block, pre- or postincision, also does not appear to be of clinical significance, 6 and this has been discussed at length by Katz and Clarke. 148 This suggests that either postoperative nerve impulse activity or slower changes in synaptic neuroplasticity in the CNS, or changes in the signaling properties of non-neuronal cells, such as microglia, in the CNS are affected by local anesthetics given for peripheral nerve block.…”

Section: Discussionmentioning

confidence: 99%

Preventive Analgesia by Local Anesthetics

Barreveld

Witte

Chahal³

et al. 2013

Anesthesia &Amp; Analgesia

145

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The use of local anesthetics to reduce acute postoperative pain has a long history, but recent reports have not been systematically reviewed. In addition, the need to include only those clinical studies that meet minimum standards for randomization and blinding must be adhered to. In this review we have applied stringent clinical study design standards to identify publications on the use of perioperative local anesthetics. We first examined several types of peripheral nerve blocks, covering a variety of surgical procedures, and second, for effects of intentionally administered IV local anesthetic (lidocaine) for suppression of postoperative pain. Thirdly, we have examined publications in which vascular concentrations of local anesthetics were measured at different times after peripheral nerve block procedures, noting the incidence when those levels reached ones achieved during intentional IV administration. Importantly, the very large number of studies using neuraxial blockade techniques (epidural, spinal) has not been included in this review but will be dealt with separately in a later review. The overall results showed a strongly positive effect of local anesthetics, by either route, for suppressing postoperative pain scores and analgesic (opiate) consumption. In only a few situations were the effects equivocal. Enhanced effectiveness with the addition of adjuvants was not uniformly apparent. The differential benefits between drug delivery before, during, or immediately after a surgical procedure are not obvious, and a general conclusion is that the significant antihyperalgesic effects occur when the local anesthetic is present during the acute postoperative period, and its presence during surgery is not essential for this action.

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“…Although the dose of the agent can be limited and the volume achieved with dilution, it is still unclear whether the concentration of the solution significantly affects onset or duration of action. One report using a fixed dose of local anaesthetic diluted in different volumes (different concentrations) found no difference in onset or duration (Bertini and others 2009). While another report where volume was fixed but concentration increased (dose increased) found shorter onset times with no differences in intensity of blockade as concentration of the agent increased (Casati and others 1999).…”

Section: Discussionmentioning

confidence: 99%

Different volumes of injectate using electrostimulator and blinded techniques for brachial plexus block in dogs

et al. 2013

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To compare different volumes of injectate using electrostimulator (ES)-guided and blind brachial plexus blockade (BPB) techniques in dogs. Prospective, randomised, blinded study. Fifty-eight healthy adult purpose-bred beagle dogs. Animals were randomised into 4 groups based on the volume of methylene blue 0.1 per cent administered for BPB, three using ES technique: E1 (0.2 ml/kg, n=22), E2 (0.6 ml/kg, n=22), and E3 (1.0 ml/kg, n=14), and one using blinded technique B4 (1.0 ml/kg, n=14). After euthanasia, the axillary region was dissected and nerves identified by a blinded evaluator. Success was defined as 3/4 nerves stained, or presence of dye in the tissue immediately surrounding the plexus. There were no significant differences between groups when total nerve count, adjacent staining, success rate (92.8-100 per cent), or rate of haematoma were evaluated. The musculocutaneous nerve was significantly more targeted in B4 than E1 and E2, but not E3. Electrostimulator-guided BPB using lower volumes of injectate had similar success rate as the blinded technique using higher volume, thus, lower volumes can be used without compromising success. When an ES is not available, the blind technique with 1 ml/kg is also acceptable. However, when performing an ES-guided BPB, volumes as low as 0.2 ml/kg can be used. As volume is increased, the musculocutaneous nerve becomes more likely to be targeted.

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Does Local Anesthetic Dilution Influence the Clinical Effectiveness of Multiple-Injection Axillary Brachial Plexus Block?

Abstract: An axillary brachial plexus block induced with a multiple-injection technique with mepivacaine 400 mg yields a high success rate regardless of the volume of anesthetic injected.

Cited by 21 publications

References 17 publications

Ultrasound-guided lateral and subcostal transversus abdominis plane block in calves: a cadaveric study

Ultrasound-guided lateral and subcostal transversus abdominis plane block in calves: a cadaveric study

Preventive Analgesia by Local Anesthetics

Different volumes of injectate using electrostimulator and blinded techniques for brachial plexus block in dogs

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