Nerve injury after peripheral nerve blockade—current understanding and guidelines

O’Flaherty, David; McCartney, Colin J. L.; Ng, Su Cheen

doi:10.1016/j.bjae.2018.09.004

Cited by 34 publications

(24 citation statements)

References 26 publications

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“…Ropivacaine is a vasoconstrictor and, therefore, the addition of adrenaline does not increase the duration of action or maximum safe dose [21] but increases the susceptibility to neurotoxicity due to decreased perfusion to the axon [22, 23]. These negative effects on blood flow are cumulative; for example, lidocaine 2% with adrenaline 5 μg.ml −1 will reduce neural blood flow by around 80% [24]. To enhance the stability of the mixture, local anaesthetics containing adrenaline are also more acidic than their plain counterparts [25]; the proportion of unionised local anaesthetic is, therefore, reduced.…”

Section: Resultsmentioning

confidence: 99%

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Nestor

Sepúlveda

et al. 2021

Anaesthesia

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Summary Various techniques have been explored to prolong the duration and improve the efficacy of local anaesthetic nerve blocks. Some of these involve mixing local anaesthetics or adding adjuncts. We did a literature review of studies published between 01 May 2011 and 01 May 2021 that studied specific combinations of local anaesthetics and adjuncts. The rationale behind mixing long‐ and short‐acting local anaesthetics to hasten onset and extend duration is flawed on pharmacokinetic principles. Most local anaesthetic adjuncts are not licensed for use in this manner and the consequences of untested admixtures and adjuncts range from making the solution ineffective to potential harm. Pharmaceutical compatibility needs to be established before administration. The compatibility of drugs from the same class cannot be inferred and each admixture requires individual review. Precipitation on mixing (steroids, non‐steroidal anti‐inflammatory drugs) and subsequent embolisation can lead to serious adverse events, although these are rare. The additive itself or its preservative can have neurotoxic (adrenaline, midazolam) and/or chondrotoxic properties (non‐steroidal anti‐inflammatory drugs). The prolongation of block may occur at the expense of motor block quality (ketamine) or block onset (magnesium). Adverse effects for some adjuncts appear to be dose‐dependent and recommendations concerning optimal dosing are lacking. An important confounding factor is whether studies used systemic administration of the adjunct as a control to accurately identify an additional benefit of perineural administration. The challenge of how best to prolong block duration while minimising adverse events remains a topic of interest with further research required.

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Section: Resultsmentioning

confidence: 99%

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Nestor

Sepúlveda

et al. 2021

Anaesthesia

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“…Femoral artery, vein and nerve were determined with the help of ultrasound (SonoScape S6 Ultrasound; SonoScape Medical Corp, Guangdong, China) and linear ultrasound probe (L741 10.0-5.0 MHz Transducer; SonoScape Medical Corp, Guangdong, China). The needle (Stimuplex A 22Gx2" Insulated Needle; Braun, Melsungen, Germany) was connected to a nerve stimulator (Stimuplex HNS 12; Braun, Melsungen, Germany) which was set up to deliver 0,32 mAh current with 1 Hz frequency and 0,1 ms length to avoid intraneural injection [7]. The probe was placed in transverse plane and the needle was approached in-plane aspect from lateral to medial.…”

Section: Methodsmentioning

confidence: 99%

Efficiency of Femoral Nerve Block for Recovery after Primary Total Knee Arthroplasty

Kayalı

2021

Preprint

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Purpose The aim of our study is to evaluate the efficiency of femoral nerve block on recovery after primary total knee arthroplasty. Our primary goal is to provide adequate analgesia with a lower concentration of bupivacaine (0.125%) as well as the usual concentration (0.25%). Comparing the degree of motor block, side effects, postoperative pain scores, opioid consumption, and ambulation and discharge times are our secondary goals. Methods The study was conducted as randomized, controlled and double blind. Sixty three patients were randomised into three groups: G125(n:21) received FNB with 20ml of 0,125% bupivacaine, G25(n:21) received 10ml of 0,25% bupivacaine and GCont(n:21) received no block. FNB was applied with ultrasound guidance after the operation. Pain scores(NRS) at certain time intervals, total opioid consumption, motor block, knee flexion and discharge times were recorded. Results For GCont, pain scores were significantly higher at 2nd, 6th, 12th and 24th hour postoperatively, total opioid consumption was higher(G125:75mg, G25:0mg, GCont:280mg) and first opioid demand time was earlier(G125:12th hour, G25:21st hour GCont:2nd hour). First knee flexion time and mobilization time were also delayed for GCont. G25 had lower scores for quadriceps muscle strength(G25:3/5, G125:4/5, GCont:5/5, Manual Test at 6th Hour), but this did not affect mobilization compared to G125. Conclusion G125 had lower quadriceps muscle strength loss compared to the G25 and earlier mobilization and flexion times, low opioid consumption and low pain scores compared to the control group. In this respect, we believe the femoral nerve block with 0,125% bupivacaine proves to be a suitable option for analgesia with the potential of maintaining enough movement for recovery after TKA.

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“…Однако, по данным исследований, ППН не всегда связано с РА и является полиэтиологическим Анестезиология и реаниматология Anesthesiology and Resuscitation явлением, зависящим от вида операции, положения пациента на операционном столе и многих других факторов [1]. Точную частоту ППН в периоперационном периоде установить сложно из-за относительно редкой встречаемости, а также сложности проведения и методологической неоднородности доступных исследований (в т. ч. трудности в установлении причинно-следственной связи между БПН и поврежденным нервом) [2,3]. Доступные в литературе данные о распространенности данного повреждения, вероятно, не отражают реальную картину из-за последствий, связанных с судебной медициной и репутацией медицинского учреждения [4].…”

unclassified

“…Доступные в литературе данные о распространенности данного повреждения, вероятно, не отражают реальную картину из-за последствий, связанных с судебной медициной и репутацией медицинского учреждения [4]. Частота встречаемости варьируется в зависимости от типа выполненной блокады [2,4].…”

unclassified

“…При определенных видах операций отмечается различная вероятность ППН [2]: нейрохирургия -0,07%; кардиохирургия -0,077%; общая хирургия -0,05%; ортопедия: 1) операции на плечевом суставе (артроскопия -0,1-10%, эндопротезирование плечевого сустава -0,8-4,3%); 2) операции на локтевом суставе (артроскопия -1,7-4,2% (часто преходящие), протезирование локтевого сустава -до 10%); 3) операции на тазобедренном суставе (тотальное эндопротезирование тазобедренного сустава -1%, артроскопия -0,4-13,3%); 4) операции на коленном суставе (тотальное эндопротезирование коленного сустава -0,3-9,5%, пластика передней крестообразной связки -0,3-77%).…”

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Peripheral Nerve Injury during Regional Anesthesia in the Perioperative Period as a Multifactorial Problem (Literature Review)

Теренин¹,

Титова²,

Довгалевич³

et al. 2022

Хирургия. Восточная Европа

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Повреждение периферических нервов в периоперационном периоде – явление, которому посвящено множество исследований. Полиэтиологичность повреждения впечатляет. Факторы, влияющие на развитие послеоперационной периферической нейропатии, включают в себя анатомические особенности строения нерва на разных уровнях, особенности кровоснабжения нерва, проведение регионарной анестезии, хирургическое вмешательство и осложнения, напрямую не связанные с анестезией или непосредственно с хирургической техникой. Знание классификаций повреждений нервных волокон позволяет глубже понять патофизиологические механизмы осложнений со стороны периферической нервной системы. Сложность диагностики и выявления причин послеоперационных нейропатий заставляет разрабатывать алгоритмы наблюдения за пациентом с целью раннего выявления проблем и своевременного начала лечения. В обзорной статье приводится информация о повреждении периферических нервов в периоперационном периоде для понимания аспектов профилактики этого потенциально серьезного осложнения. Рассмотрены анатомические особенности строения периферического нерва относительно рисков повреждения и устойчивости к ним, патофизиология травматизации нервов с подробным разбором классификаций. Приведены данные о профилактике повреждения периферических нервов со стороны анестезиологической и хирургической бригад, а также многие аспекты послеоперационного ведения пациентов. Профилактика повреждения периферических нервов в периоперационном периоде невозможна без глубокого понимания факторов развития и патогенеза этого осложнения. Injury to peripheral nerves in the perioperative period is a phenomenon that has been the subject of many studies. The polyetiology of damage is impressive. Factors influencing the development of postoperative peripheral neuropathy include anatomical features of the structure of the nerve at different levels, features of the blood supply to the nerve, regional anesthesia, surgical intervention, and complications not directly related to anesthesia or directly to the surgical technique. Knowledge of the classifications of nerve fiber damage allows a deeper understanding of the pathophysiological mechanisms of complications from the peripheral nervous system. The complexity of diagnosing and identifying the causes of postoperative neuropathies makes it necessary to develop algorithms for monitoring the patient in order to identify problems early and start treatment in a timely manner. The review article provides information on peripheral nerve injury in the perioperative period to understand the prevention aspects of this potentially serious complication. The anatomical features of the structure of the peripheral nerve in relation to the risks of damage and resistance to them, the pathophysiology of nerve damage with a detailed analysis of the classifications are considered. Data on the prevention of damage to peripheral nerves by the anesthetic and surgical teams are presented. As well as many aspects of postoperative management of patients. Prevention of damage to peripheral nerves in the perioperative period is impossible without a deep understanding of the factors of development and pathogenesis of this complication.

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Nerve injury after peripheral nerve blockade—current understanding and guidelines

Cited by 34 publications

References 26 publications

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Efficiency of Femoral Nerve Block for Recovery after Primary Total Knee Arthroplasty

Peripheral Nerve Injury during Regional Anesthesia in the Perioperative Period as a Multifactorial Problem (Literature Review)

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