Enhanced brachial plexus blockade. Effect of pain and muscular exercises on the efficiency of brachial plexus blockade

Okasha, A; El-Attar, A. H.; Soliman, Heithem

doi:10.1111/j.1365-2044.1988.tb08987.x

Cited by 16 publications

(2 citation statements)

References 8 publications

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“…242 Because local anesthetic blockade of sodium channels is usedependent, exercising the arm after block placement significantly speeds up anesthesia onset but does not improve success or prolong duration. 243 Conversely, the use of transcutaneous nerve stimulation to Bexercise the arm[ is of no benefit. 244 Rapid injection of local anesthetic reduces anesthetic spread and increases failure rate.…”

Section: Physical Manipulationsmentioning

confidence: 99%

Upper Extremity Regional Anesthesia

Neal¹,

Gerancher

Hebl

et al. 2009

Regional Anesthesia and Pain Medicine

310

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Brachial plexus blockade is the cornerstone of the peripheral nerve regional anesthesia practice of most anesthesiologists. As part of the American Society of Regional Anesthesia and Pain Medicine's commitment to providing intensive evidence-based education related to regional anesthesia and analgesia, this article is a complete update of our 2002 comprehensive review of upper extremity anesthesia. The text of the review focuses on (1) pertinent anatomy, (2) approaches to the brachial plexus and techniques that optimize block quality, (4) local anesthetic and adjuvant pharmacology, (5) complications, (6) perioperative issues, and (6) challenges for future research.Upper extremity regional anesthesia has been a mainstay of the anesthesiologist's armamentarium since Hall 1 first reported the use of cocaine to block the brachial plexus in 1884. Recognizing that upper extremity neural blockade represents the most frequent use of peripheral nerve blocks in most anesthesiologists' practice, 2 in 2001, the American Society of Regional Anesthesia and Pain Medicine (ASRA) undertook a critical review of all available English-language publications pertinent to this topic. The resulting extensive source document was synthesized into a comprehensive review article 3 that was published in 2002; both the source and the review documents will be updated approximately every 5 years.Rather than publishing only new material that has become available since 2002, the original review article has been completely revised so that readers may continue to view the subject matter in its entirety. New topics in this review include ultrasound-guided brachial plexus block, continuous catheter-based analgesia, and a collection of new images * by medical illustrator, Jennifer Gentry (www.gentryvisualization.com). This review summarizes the essential scholarly work available from the source document, which can be viewed at Copyright © 2009 by American Society of Regional Anesthesia and Pain Medicine Address correspondence to: Joseph M. Neal, MD, 1100 Ninth Ave (B2-AN), Seattle, WA 98101 (anejmn@vmmc.org). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of this entity. James P. Rathmell, MD, served as acting editor-in-chief for this article.Financial support: None. NIH Public Access Author ManuscriptReg Anesth Pain Med. Author manuscript; available in PMC 2010 March 1. Published in final edited form as:Reg Anesth Pain Med. 2009 ; 34(2): 134-170. doi:10.1097/AAP.0b013e31819624eb. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript www.asra.com. This review article strives (1) to serve as a review of pertinent anatomy, (2) to compare the effectiveness of brachial plexus approaches and techniques, (3) to present available evidence to guide selection of pharmacological agents, (4) to describe the complications inherent to upper extremity anesthesia, (5) to consider pertinent perioperative issues, and (6) to identify informational gaps and empha...

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Section: Physical Manipulationsmentioning

confidence: 99%

Upper Extremity Regional Anesthesia

Neal¹,

Gerancher

Hebl

et al. 2009

Regional Anesthesia and Pain Medicine

310

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“…9 Yet, correct pathogen identification is paramount for timely management, successful antibiotic stewardship, and for minimizing the growing risk of antibiotic-resistant organisms, which is an increasingly concerning barrier to care in the United States. While the incidence of causative organisms for pediatric OM varies by region, Staphylococcus aureus is often reported as the most common pathogen 10,11 ; a recent case study of cutaneous methicillin-resistant S aureus infections demonstrated a resistance to clindamycin in 13% of cases, highlighting the rapid growth of multi-drug resistant organisms. 12 As such, in patients who otherwise may not require surgery, interventional radiology (IR)-guided biopsy may allow for timely, sensitive, and accurate pathogen identification.…”

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confidence: 99%

The Utility of IR-Guided Biopsy in the Treatment of Pediatric Osteomyelitis

Gajewski

Chen

Upfill‐Brown

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Accurate and efficient diagnosis, as well as a consistent and effective treatment of acute hematogenous osteomyelitis, are paramount to ensure successful clinical outcomes. Noninvasive measures of isolating the causative pathogen from blood cultures have low sensitivity, with published rates often <50%. The use of interventional radiology (IR)-guided percutaneous biopsy has gained traction as a nonsurgical means of obtaining tissue cultures with a reported increased sensitivity of > 90%. This study aims to determine the utility of IR-guided biopsy in the management of pediatric patients with acute hematogenous pediatric osteomyelitis (OM). Methods: An IRB-approved retrospective review was completed of children younger than 18 years admitted to a single institution for treatment of magnetic resonance imaging or culture/biopsyproven acute hematogenous OM. Patients were excluded for the diagnosis of chronic recurrent multifocal OM, incomplete documentation, treatment initiation at an outside institution, open surgical debridement, and concomitant septic arthritis. Patients who underwent IR-guided biopsy were compared with those treated empirically without biopsy. Results: Fifty patients were included for analysis. Fifteen (30%) had IR-guided biopsies; 35 (70%) were treated empirically. The average age at diagnosis was 11.8 years old (SD: 4.9). Of the 15 patients who underwent IR-guided biopsy, a pathogen was identified in 12 cases (80%); 14 of these patients had concomitant blood cultures with only 1 (7%) positive result (P < 0.01). Of the 11 patients with positive IR-guided biopsy results in the setting of negative blood cultures, 9 (82%) had alterations in their antibiotic regimen as a result of the biopsy. The average time from blood sample collection to definitive antibiotic initiation was nearly double that of time from IRguided biopsy collection to definitive antibiotic initiation (70.8 vs. 36 h; P < 0.01). Conclusion: IR-guided biopsy increased pathogen identification by 47% over blood cultures alone and decreased the time to definitive antibiotics. As such, IR-guided biopsy is an effective and safe diagnostic tool for pathogen identification and appropriate antibiotic selection. Orthopaedic surgeons are encouraged to incorporate IR-guided biopsy early in the treatment pathway for patients with acute OM without an indication for open surgical intervention.

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Regionalanästhesie

Craß¹,

Gerheuser²

Die Anästhesiologie

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Enhanced brachial plexus blockade. Effect of pain and muscular exercises on the efficiency of brachial plexus blockade

Cited by 16 publications

References 8 publications

Upper Extremity Regional Anesthesia

Upper Extremity Regional Anesthesia

The Utility of IR-Guided Biopsy in the Treatment of Pediatric Osteomyelitis

Regionalanästhesie

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