Thermal quantitative sensory testing to assess the sensory effects of three local anesthetic solutions in a randomized trial of interscalene blockade for shoulder surgery

Sermeus, Luc; Hans, Guy; Schepens, Tom; Bosserez, Nathalie M.-L.; Breebaart, Margaretha B.; Smitz, Carine J.; Vercauteren, M.

doi:10.1007/s12630-015-0505-x

Cited by 8 publications

(6 citation statements)

References 32 publications

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“…The thermal threshold has been used in previous studies to get a more objective measurement of the analgesic effect [ 24 , 25 ]. In dogs, TT has been reliably measured [ 26 ] to evaluate pain in different conditions [ 27 , 28 , 29 ] and to evaluate the efficacy of analgesics [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…In dogs, TT has been reliably measured [ 26 ] to evaluate pain in different conditions [ 27 , 28 , 29 ] and to evaluate the efficacy of analgesics [ 30 ]. Thermal threshold testing has been used in human anaesthesia to assess the effect of loco-regional anaesthesia techniques and the differences among several drugs [ 25 ]. Our study showed a significantly increased thermal threshold in all dermatomes (T 10 , T 13 , L3 ) on both sides of the skin of the abdominal wall when it was assessed 30 min after the recovery, compared with the basal values before the block.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Quadratus Lumborum Block as Part of an Opioid-Free Anaesthesia for Canine Ovariohysterectomy

Viscasillas

Sanchis‐Mora

Burillo

et al. 2021

Animals

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Quadratus lumborum block (QLB) is used to provide analgesia for abdominal surgery in humans. The aim of this study was to assess an anaesthetic protocol involving the QLB for canine ovariohysterectomy. Ten dogs were included. Anaesthetic protocol consisted of premedication with IM medetomidine (20 μg kg−1) and SC meloxicam (0.1 mg kg−1), induction with propofol to effect, and maintenance with sevoflurane in oxygen/medical air. QLB was performed injecting 0.4 mL kg−1 of 0.25% bupivacaine/iohexol per side. Computed Tomography (CT) was performed before and after surgery. Fentanyl was administered as rescue analgesia during surgery. The Short Form of The Glasgow Composite Pain Scale and thermal threshold (TT) at the level of the elbow, T10, T13 and L3 were assessed before premedication and every hour postoperatively. Methadone was given as rescue analgesia postoperatively when pain score was >3. A Yuen’s test on trimmed means for dependent samples was used to analyse the data (p < 0.05). CT images showed spreading of the contrast/block for a median (range) of 3 (2–5) vertebrae, without differences between preoperative and postoperative images. One dog needed rescue analgesia during surgery. Pain score was less than 4/24 in all the animals during the first 4 h after surgery. TT showed a significant increased signal in all the areas tested, apart from the humerus, 30 min after surgery. The QLB may provide additional analgesia for canine ovariohysterectomy. Further studies are needed to assess the specific contribution of the QLB in abdominal analgesia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of Quadratus Lumborum Block as Part of an Opioid-Free Anaesthesia for Canine Ovariohysterectomy

Viscasillas

Sanchis‐Mora

Burillo

et al. 2021

Animals

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“…37 Limitations of this study include the generalisability of results from a small number of volunteers to the large, diverse group undergoing surgery. While pinprick sensation is commonly used to evaluate time-to-event regional anaesthesia outcomes and there is growing experience for utilisation of QST in regional anaesthesia studies, 20,38 it is unclear exactly how these modalities correlate to post-surgical pain. Another limitation was that some volunteers left before complete resolution of QST modalities, which required forward extrapolation for AUC analyses.…”

Section: Discussionmentioning

confidence: 99%

“…Four QST modalities were assessed: cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), and heat pain threshold (HPT). 20 A standard Peltier thermode was applied over the anaesthetised area of the blocked hand at a starting temperature of 32 C. Thermode temperature was decreased or increased by 1 C s À1 . Volunteers were asked to signal CDT, WDT, CPT, and HPT by pressing a handset button with the contralateral hand.…”

Section: Neurological Assessmentsmentioning

confidence: 99%

Effect of intravenous dexamethasone on the anaesthetic characteristics of peripheral nerve block: a double-blind, randomised controlled, dose–response volunteer study

Short

El‐Boghdadly

Clarke

et al. 2020

British Journal of Anaesthesia

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Background: Intravenous dexamethasone is thought to prolong the duration of peripheral nerve block, but the doseeresponse relationship remains unclear. The aim of this volunteer study was to evaluate the doseeresponse effect of i.v. dexamethasone on the prolongation of median nerve block. Methods: In a double-blind, randomised controlled study, 18 volunteer subjects received two median nerve blocks separated by a washout period. One block was conducted alongside an infusion of saline and the other alongside i.v. dexamethasone 2, 4, or 8 mg. The primary outcome was time to return of normal pinprick sensation. Secondary outcomes included thermal quantitative sensory testing (QST) for the time to return of cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), area under QST curves, grip strength, and the incidence of adverse effects. Results: The primary outcome, time to recovery of pinprick sensation, was similar between volunteers receiving saline or i.v. dexamethasone, regardless of dose (P¼0.99). The time to recovery of QST milestones was similar between groups, although area under QST curves indicated prolongation of CDT (0 vs 8 mg, P¼0.002) and WDT (0 vs 2 mg, P¼0.008; 0 vs 4 mg, P¼0.001; 0 vs 8 mg, P<0.001). There was no difference in motor recovery or adverse effects. Conclusions: Intravenous dexamethasone failed to significantly prolong the duration of pinprick anaesthesia regardless of dose. However, area under QST curve analysis indicated a dose-independent prolongation of CDT and WDT, the clinical significance of which is unclear. Clinical trial registration: NCT02864602 (clinicaltrials.gov).

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“…Although perforation of the epineurium and subsequent injection does not always result in neurological damage , we should remain vigilant and use all tools at our disposal to avoid intraneural injection . Since we are performing the tangential approach routinely in clinical practice, we have no concerns about the effectiveness of the block .…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided approach to nerves (direct vs. tangential) and the incidence of intraneural injection: a cadaveric study

et al. 2017

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This study evaluated the incidence of nerve puncture and intraneural injection based on the needle approach to the nerve (direct vs. tangential). Two expert operators in regional anaesthesia performed in-plane ultrasound-guided nerve blocks (n = 158) at different levels of the brachial plexus in cadavers, aiming either directly for the nerve (n = 77) or tangentially inferior to the nerve (n = 81). After reaching the outer limit of the nerve, the needle was intentionally advanced approximately 1 mm in both approaches, and 0.2-0.5 ml of saline was injected. Each operator classified (in real time) the needle tip and injectate as intraneural or not. Video clips showing the final position of the needle and the injection were evaluated in the same manner by seven independent expert observers who were blinded to the aims of this study. In addition, 20 injections were performed with ink for histological evaluation. Intraneural injections of saline were observed by the operator in 58% (45/77) of cases using the direct approach and 12% (10/81) of cases using the tangential approach (p < 0.001). The independent observers agreed with the operator in a substantial number of cases (Cohen's kappa index 0.65). Histological studies showed intraneural spread in 83% (5/6) of cases using the direct approach and in 14% (2/14) of cases using the tangential approach (p = 0.007). No intrafascicular injections were observed. There was good agreement between the operators' assessment and subsequent histological evaluation (Cohen's kappa = 0.89). Simulation of an unintentional/accidental advancement of the needle 'beyond the edge' of the nerve suggests significantly increased risk of epineural perforation and intraneural injection when a direct approach to the nerve is used, compared with a tangential approach.

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Thermal quantitative sensory testing to assess the sensory effects of three local anesthetic solutions in a randomized trial of interscalene blockade for shoulder surgery

Cited by 8 publications

References 32 publications

Evaluation of Quadratus Lumborum Block as Part of an Opioid-Free Anaesthesia for Canine Ovariohysterectomy

Evaluation of Quadratus Lumborum Block as Part of an Opioid-Free Anaesthesia for Canine Ovariohysterectomy

Effect of intravenous dexamethasone on the anaesthetic characteristics of peripheral nerve block: a double-blind, randomised controlled, dose–response volunteer study

Ultrasound‐guided approach to nerves (direct vs. tangential) and the incidence of intraneural injection: a cadaveric study

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