Obesity in regional anesthesia – a risk factor for peripheral catheter‐related infections

Bomberg, Hagen; Albert, Noemi; Schmitt, Katja; Gräber, Stefan; Kessler, Paul; Steinfeldt, Thorsten; Hering, W.; Gottschalk, André; Standl, Thomas; Stork, Jan; Meißner, Winfried; Teßmann, R.; Geiger, P.; Koch, Thea; Spies, Claudia; Volk, Thomas; Kubulus, Christine

doi:10.1111/aas.12548

Cited by 27 publications

(15 citation statements)

References 35 publications

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“…Obesity also increases the risk of peripheral catheter-related infections under regional anesthesia. [14] In the current case, both ICB and SCB provided sufficient anesthesia in the surgical region. We initially planned to perform ICB or CCB because of the relatively low reported incidence of HDP.…”

Section: Retrospective Analysismentioning

confidence: 63%

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Dyspnea induced by hemidiaphragmatic paralysis after ultrasound-guided supraclavicular brachial plexus block in a morbidly obese patient

et al. 2022

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Rationale: Hemidiaphragmatic paralysis (HDP) is a frequent complication of the brachial plexus block, caused by unintentional blockade of ipsilateral phrenic nerve. HDP did not rise enough alarm and attention to most anesthesiologists, because most patients with no coexisting comorbid diseases are asymptomatic and able to tolerate it. However, it may cause severe respiratory complication for patients with preexisting compromised cardiorespiratory function. Patient concerns: A 67-year-old woman with morbidly obesity was planned to receive opening reduction and internal fixation of right humeral shaft fracture under regional anesthesia considering less respiratory and cardiovascular system interference compared with general anesthesia. Diagnoses: After ultrasound guided supraclavicular brachial plexus block, the patient developed severe hypoxia and hypercapnia.Unintentional block of phrenic nerve and diaphragm paralysis was diagnosed by diaphragm ultrasound, which was considered as the main reason of severe hypoxia. Interventions: It led to a conversion from regional anesthesia to general anesthesia with endotracheal intubation for patient's safety and smooth operation. Outcomes: The unintentional phrenic nerve block leads to a prolonged ventilation time, length of stay in intensive care unit and length of stay in hospital. Lessons: This case report highlights the risk of diaphragm paralysis in morbidly obese patients. Though new diaphragm sparing brachial plexus block (BPB) methods were developed intended to reduce the risk of HDP, no approaches could absolutely spare phrenic nerve involvement. Therefore, clinicians should always consider the risk of HDP associated with BPBs. For each individual, a detailed preoperative evaluation and sufficient preparation are paramount to avoid serious complications.

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Section: Retrospective Analysismentioning

confidence: 63%

“…Obesity also increases the risk of peripheral catheter-related infections under regional anesthesia. [ 14 ]…”

Section: Discussionmentioning

confidence: 99%

Dyspnea induced by hemidiaphragmatic paralysis after ultrasound-guided supraclavicular brachial plexus block in a morbidly obese patient

et al. 2022

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“…In another study, obesity was demonstrated to be an independent risk factor for catheter infections in PNBs but not for neuraxial blocks (69) . As adipose tissue is perfused poorly and subcutaneous tissue hypoxia occurs in obese people, the risk of wound infection increases with the decreased oxygen partial pressure.…”

Section: Catheter Placements and Site Infectionsmentioning

confidence: 94%

Regional Anesthesia in Adult Patients with Obesity

Şalvız¹

2020

jarss

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Obesity is one of the important public health concerns, and described as abnormal accumulation of fat. It is associated with cardiopulmonary physiological alterations and a number of comorbidities (obstructive sleep apnea, metabolic syndrome, coronary artery disease…). Not only surgical and anesthetic managements of obese patients are challenging but also their perioperative morbidity and mortality rates are higher. We, as anesthesiologists, face these patients at an increasing rate with time. Since we prefer regional anesthesia techniques to general anesthesia in appropriate surgery types; we would avoid airway manipulations, opioid consumption and surgery-related stress responses. Regional anesthesia techniques are attractive options; however, they have unique challenges such as requirement for special equipment, crucial positioning, multiple attempts at redirecting needle/catheter, difficulty in palpation of anatomical landmarks, and increased rate of failed blocks in patients with obesity. Ultrasound-guidance provides us visualization of anatomical structures, decreased rates of needle insertions, and orientations , procedural trauma, side effects/complications and increased rates of block success. This review focuses on the obesity-related comorbidities; possible problems occur during the performance of neuroaxial, upper extremity, lower extremity, thoracic and abdominal wall block techniques performed on obese patients; literature supported suggestions and the role of ultrasound to manage these situations.

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“…As a consequence, many of the following net-ra studies focused on the identification of risk factors for catheter-related infections. For example, odds for catheter-related infections are increased in diabetics (OR: 1.26, 95%CI: 1.02-1.55) [47] or in obese patients with peripheral catheters (OR: 1.69, 95%CI: 1.25-2.28) [48]. Moreover, the catheter-related infection profile over up to 15 days was determined in a cohort of 44,555 patients showing that infection risk starts to increase slowly at the fourth day after catheter placement [49].…”

Section: Big Data Initiatives In Acute Pain and Regional Anesthesia Researchmentioning

confidence: 99%

Big Data in Studying Acute Pain and Regional Anesthesia

Müller-Wirtz

Volk

2021

JCM

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The digital transformation of healthcare is advancing, leading to an increasing availability of clinical data for research. Perioperative big data initiatives were established to monitor treatment quality and benchmark outcomes. However, big data analyses have long exceeded the status of pure quality surveillance instruments. Large retrospective studies nowadays often represent the first approach to new questions in clinical research and pave the way for more expensive and resource intensive prospective trials. As a consequence, the utilization of big data in acute pain and regional anesthesia research has considerably increased over the last decade. Multicentric clinical registries and administrative databases (e.g., healthcare claims databases) have collected millions of cases until today, on which basis several important research questions were approached. In acute pain research, big data was used to assess postoperative pain outcomes, opioid utilization, and the efficiency of multimodal pain management strategies. In regional anesthesia, adverse events and potential benefits of regional anesthesia on postoperative morbidity and mortality were evaluated. This article provides a narrative review on the growing importance of big data for research in acute postoperative pain and regional anesthesia.

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Obesity in regional anesthesia – a risk factor for peripheral catheter‐related infections

Abstract: This retrospective cohort study suggests that obesity is an independent risk factor for peripheral, but not neuraxial, catheter-related infections.

Cited by 27 publications

References 35 publications

Dyspnea induced by hemidiaphragmatic paralysis after ultrasound-guided supraclavicular brachial plexus block in a morbidly obese patient

Dyspnea induced by hemidiaphragmatic paralysis after ultrasound-guided supraclavicular brachial plexus block in a morbidly obese patient

Regional Anesthesia in Adult Patients with Obesity

Big Data in Studying Acute Pain and Regional Anesthesia

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