Ultrasound-guided bilateral costoclavicular brachial plexus blocks for single-stage bilateral upper limb surgeries: Abstain or indulge

Mistry, Tuhin; Balavenkatasubhramanian, Jagannathan; Natarajan, Vivekanandan; Kuppusamy, Elayavendhan

doi:10.4103/joacp.joacp_222_18

Cited by 3 publications

(6 citation statements)

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“…[ 9 ] Similar to this study, it was stated in another study that a time interval between blocks would prevent peak systemic absorption rate overlap for each block, thus preventing a potential LAST risk. [ 10 ] In another study, it was suggested that a time interval of at least 60 min should be considered between each block in case of multiple block applications to prevent LAST. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

“…In our blocks, we used lidocaine as an additional LA along with bupivacaine to keep the dose of bupivacaine low and for the LA solution to act quickly. As seen in the literature, many studies[ 9 10 11 ] recommend that these blocks be performed at regular intervals in order to prevent reaching the peak plasma concentration of LA in bilateral (multiple) blocks. However, since we used both low-dose and low-volume LA solutions in our US-guided blocks, we assumed that we would not reach the peak plasma concentration that could cause LAST.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided bilateral infraclavicular brachial plexus block

Şengel¹,

Seçilmiş²

2022

Saudi Journal of Anaesthesia

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Anesthesiologists avoid multiple upper extremity peripheral nerve block applications due to complications such as increased phrenic nerve palsy and local anesthetic systemic toxicity risk. With the introduction of ultrasound into clinical life and the increase in the number of experienced anesthesiologists, such complications are less common. We also discussed three cases that we think may contribute to the literature on this subject. Our first case was scheduled for operation due to a trigger finger in his left hand and carpal tunnel syndrome in his right hand. Our second case was scheduled for surgery due to distal radius and ulnar fractures in both forearms. Our third case scheduled for operation for a fracture of the right forearm distal radius and a second metacarpal fracture in the left hand. In this report series, we present our experience of bilateral infraclavicular block, which we successfully performed in three cases and did not encounter any complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided bilateral infraclavicular brachial plexus block

Şengel¹,

Seçilmiş²

2022

Saudi Journal of Anaesthesia

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“…Few cadaveric and therapeutic trials have opined that, CCB may be utilized as a substitute to ISB for postoperative pain relief after shoulder surgery. Mistry et al 16 has given15 mL of local anesthetics in bilateral CCB and found good analgesia without phrenic nerve paralysis. Also, Koyyalamudi et al 17 in a human cadaveric trial approved this.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Costoclavicular Block and Interscalene Block for Pain Relief after Arthroscopic Shoulder Surgery

Pradhan

Jayasingh

Nanda

et al. 2021

International Journal of Recent Surgical and Medical Sciences

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Introduction Interscalene block (ISB) is commonly used for efficient pain relief after arthroscopic shoulder surgery. But, it is linked with a greater occurrence of unilateral diaphragmatic paralysis (UDP). This may add to patient dissatisfaction and also may not be tolerated well by patients having respiratory diseases. We have compared the efficacy of costoclavicular block (CCB) with ISB for postoperative analgesia in patients undergoing arthroscopic shoulder surgery. Materials and Methods Fifty patients were divided into two groups of 25 each (ISB or CCB group). In total, 20 mL of 0.5% levobupivacaine along with 4 mg of dexamethasone as adjuvant was used during both ultrasound-guided ISB and CCB. Numerical rating scale (NRS) scores for pain were assessed at 0, 0.5, 1, 2, 3, 6, 12, and 24 hours in postoperative period. The mean onset time of block, time of first painkiller demand, total painkiller demand for 24 hours postoperatively, patient wellbeing, incidence of UDP, and any other complications were recorded. Results NRS pain scores in both groups at 0, 0.5, 1, 2, 3, 6, 12, and 24 hours were comparable. (p > 0.05) Mean onset time of block was earlier in ISB group contrary to CCB group (p < 0.05). There was higher occurrence of UDP in ISB group contrary to CCB group (p < 0.05). There was no notable variation regarding the time of first painkiller demand and total painkiller demand in the first 24 hours. Patients were more satisfied in CCB group contrary to ISB group. Conclusion As CCB provided equivalent analgesia in postoperative period like ISB without any risk of UDP, it can be a better substitute to ISB for pain relief in arthroscopic shoulder surgery.

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“…Ipsilateral PNP was observed in 0% or 5% with 20 ml and 8.9% with 35 ml of LA following ultrasound-guided CCB in various clinical settings. 1 , 2 , 4 Bilateral use of CCB with 15 ml of LA for each side was also reported without any clinical or sonographic evidence of PNP. 1 We have been using CCB in our daily practice since its first description in the literature and observed a relatively very low incidence of clinically significant PNP.…”

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confidence: 99%

“…The advantages of local anesthetic (LA) deposition at costoclavicular space (CCS) include the requirement of low volume as the cords are densely packed, reduce the possibility of pneumothorax and ipsilateral phrenic nerve palsy (PNP). 1 It has been shown to produce effective anesthesia/analgesia in various upper limb surgeries below the shoulder joint. Continuous CCB using a perineural catheter can be used for intraoperative surgical anesthesia and/or postoperative analgesia.…”

mentioning

confidence: 99%