Risks and Benefits of Ultrasound, Nerve Stimulation, and Their Combination for Guiding Peripheral Nerve Blocks: A Retrospective Registry Analysis

Bomberg, Hagen; Wetjen, Laura; Wagenpfeil, Stefan; Schöpe, Jakob; Kessler, Paul; Wulf, Hinnerk; Wiesmann, Thomas; Standl, Thomas; Gottschalk, André; Döffert, Jens; Hering, W.; Birnbaum, Jürgen; Kutter, B.; Winckelmann, Jörg; Liebl-Biereige, Simone; Meißner, Winfried; Vicent, O.; Koch, Thea; Bürkle, Hartmut; Sessler, Daniel I.; Volk, Thomas

doi:10.1213/ane.0000000000003480

Cited by 28 publications

(16 citation statements)

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“…Based on our observation, it was found that the number of needle punctures were less in group B and patient comfort was better due to less procedural time. This finding was corresponding with Bomber et al 19 who concluded that the combined use of US and nerve stimulation showed lower odds of unintended paresthesia (0.4 [0.2-0.8]; P = .007) compared to US alone. There were no vascular injuries observed in the either group, the use of Doppler and intermittent aspiration is always a rule whatever technique is employed.In our study, the faster onset of sensory and motor block was achieved in Group B compared to Group A. Shreshta et al 20 , also found that the onset of motor block was 16 min in nerve stimulator-assisted US guidance group, which increased to 20 min in US guidance group alone.…”

Section: Discussionsupporting

confidence: 86%

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2019

MIJOANS

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Background: Ultrasound (US) guidance and peripheral nerve stimulator for supraclavicular brachial plexus block have enhanced the success rates of the block with excellent localization. Nevertheless, only few studies are present on peripheral nerve stimulator-assisted US guidance for brachial plexus block in upper limb surgeries. Objectives: To compare US guidance with nerve stimulator-assisted US guidance for supraclavicular brachial plexus block in patients undergoing limb surgeries. Method: Patients (n = 70) undergoing elective upper limb surgeries by supraclavicular brachial plexus block were involved. Randomization of patients was done to perform supraclavicular brachial plexus block either under US guidance (Group A = 35) or under nerve stimulation-assisted US guidance (Group B = 35). Demographic data including age, gender, and weight of the patients, were recorded. Time of performance of block, onset of sensory and motor block, duration of sensory and motor block, and hemodynamic changes (pulse rate, systolic and diastolic pressure), were the parameters compared between the groups. Chi-square test and unpaired t-test were used to analyse the data. Results: Demographic data was comparable in both groups. The mean time taken for the performance of block by eliciting paraesthesia was significantly less in Group B compared to Group A (5.87 ± 1.07 vs. 10.22 ± 2.11 min; P < 0.001). The mean time taken for onset of sensory (6.79 ± 1.04 vs. 9.28 ± 1.86 min; P < 0.001) and motor blockade (14.56 ± 2.53 vs. 17.69 ± 1.45 min; P < 0.001) was also significantly less in Group B compared to Group A. Conclusion: Nerve stimulator-assisted US guidance for supraclavicular brachial plexus block is a feasible technique in patients undergoing limb surgeries, in terms of reduced time taken for the performance of the block, and the onset of sensory and motor block.

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Section: Discussionsupporting

confidence: 86%

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2019

MIJOANS

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“…Despite the shortcomings, in modern anesthesiological practice, regional anesthesia in the form of peripheral nerve blocks is becoming increasingly popular due to the lack of systemic effects on vital functions, effective analgesia in the perioperative period, the possibility of unilateral analgesia against neuroaxial techniques and economic component [23].…”

Section: Research Results and Discussionmentioning

confidence: 99%

The problem of choosing anesthesia method for surgical interventions on the lower limbs in young patients

Georgiyants

Popsuishapka

Ryndenko

et al. 2021

SR:MS

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The relevance of the topic is due to the prevalence of lower limbs injuries in people of working age, the complexity of the methods of their surgical treatment and the problem of finding the optimal method of anesthesia in terms of efficiency and safety. Objective of the study: to conduct a systematic analysis of modern scientific literature data on the possibility of using anesthesia methods during surgical interventions and in the case of anesthesia for injuries of the lower limbs in people of working age. Materials and methods. A search for scientific sources was carried out in the scientometric databases Scopus and Web of Science, Google Scholar, archives of journals using the keywords "general anesthesia", "regional anesthesia", "injuries of the lower limbs", "young people", "general anesthesia". The search depth was 8 years. Conclusions. The problem of choosing the method of anesthesia during traumatological surgeries in people of working age has no final solution. In general, both general and regional anesthesia can be used, despite their advantages and the possibility of complications in each case. However, in clinical practice over the past decade, general anesthesia is not always the best method of pain relief. But regional methods have less effect on the vital functions of the body, and the use of ultrasound navigation and modern local anesthetics in a minimum sufficient amount makes anesthesia conduction more effective and safe. The disadvantages of regional anesthesia can be avoided by combining it with general anesthesia. However, in the available literature, there are no recommendations on the differentiated choice of the method of anesthesia for surgical interventions on the lower limbs in people of working age and the factors that influence this

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“…Finally, benefits of ultrasound, nerve stimulation, and their combination for guiding peripheral nerve blocks were evaluated in 26,733 cases. The use of ultrasound alone reduced the odds of vascular and multiple skin punctures but increased the odds of paresthesia compared to the combined use of ultrasound and nerve stimulation [52].…”

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

confidence: 98%

Big Data in Studying Acute Pain and Regional Anesthesia

Müller-Wirtz¹,

Volk²

2021

Preprint

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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 analyzes 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, utilization of big data in acute pain and regional anesthesia research 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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Risks and Benefits of Ultrasound, Nerve Stimulation, and Their Combination for Guiding Peripheral Nerve Blocks: A Retrospective Registry Analysis

Abstract: Use of ultrasound alone reduced the odds of vascular and multiple skin punctures. However, the sole use of ultrasound increases the odds of paresthesia.

Cited by 28 publications

References 16 publications

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The problem of choosing anesthesia method for surgical interventions on the lower limbs in young patients

Big Data in Studying Acute Pain and Regional Anesthesia

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