Upper extremity regional anesthesia techniques: A comprehensive review for clinical anesthesiologists

Jones, Mark R.; Novitch, Matthew B.; Sen, Sudipta; Hernandez, Nadia; Haan, Johanna Blair de; Budish, Rebecca A.; Bailey, Christopher H.; Ragusa, Joseph; Thakur, Pankaj; Orhurhu, Vwaire; Urits, Ivan; Cornett, Elyse M.; Kaye, Alan D.

doi:10.1016/j.bpa.2019.07.005

Cited by 18 publications

(9 citation statements)

References 34 publications

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“…In clinical practice, BPB can be achieved through several routes, including interscalene, costoclavicular space, supraclavicular, and axillary approaches ( Bhat et al, 2020 ; Jones et al, 2020 ; Mojica et al, 2022 ). The diffusion rate of local anesthetics, the speed of vascular absorption, and the blocking sequence are different for different approaches, which will influence the effects of brachial plexus block ( Wenwen et al, 2016 ; Safa et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…The diffusion rate of local anesthetics, the speed of vascular absorption, and the blocking sequence are different for different approaches, which will influence the effects of brachial plexus block ( Wenwen et al, 2016 ; Safa et al, 2021 ). Studies have found that different approaches may produce different blocking effects even using the same concentration and dose of ropivacaine ( Bhat et al, 2020 ; Jones et al, 2020 ). Additionally, the volume of ropivacaine used for brachial plexus blocks also varies.…”

Section: Discussionmentioning

confidence: 99%

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Optimal concentration of ropivacaine for brachial plexus blocks in adult patients undergoing upper limb surgeries: a systematic review and meta-analysis

Wu,

Zhang,

Zhang

et al. 2023

Front. Pharmacol.

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Aim of the Study: Brachial plexus block (BPB) is widely used for patients undergoing upper limb surgeries. Ropivacaine is the most commonly used local anesthetic for BPB. This study aimed to identify the optimal ropivacaine concentration for BPB in adult patients undergoing upper limb surgeries.Materials and Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched to identify randomized controlled trials (RCTs) that compared the effects of different concentrations of ropivacaine for BPB in adult patients undergoing upper limb surgeries. The primary outcomes were the onset time of sensory and motor block. RevMan 5.4 software was used for analysis. The GRADE approach was used to assess evidence quality.Results: Nine studies involving 504 patients were included. Compared to 0.5% ropivacaine, 0.75% ropivacaine shortened the onset time of sensory (WMD, −2.54; 95% CI; −4.84 to −0.24; <0.0001, moderate quality of evidence) and motor blockade (WMD, −2.46; 95% CI, −4.26 to −0.66; p = 0.01; moderate quality of evidence). However, 0.5% and 0.75% ropivacaine provided similar duration time of sensory (WMD, −0.07; 95% CI, −0.88 to 0.74; p = 0.81; high quality of evidence) and motor blockade (WMD, −0.24; 95% CI, −1.12 to 0.65; p = 0.55; high quality of evidence), as well as time to first request for oral analgesia (WMD, −1.57; 95% CI, −3.14 to 0.01; p = 0.5; moderate quality of evidence).Conclusion: Moderate-quality evidence suggested that, in terms of the onset time of sensory and motor blockade, 0.75% ropivacaine is a preferred concentration for BPB in upper limb surgeries.Systematic Review Registration: identifier CRD42023392145.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Optimal concentration of ropivacaine for brachial plexus blocks in adult patients undergoing upper limb surgeries: a systematic review and meta-analysis

Wu,

Zhang,

Zhang

et al. 2023

Front. Pharmacol.

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“…The educational videos were mostly uploaded by NYSORA and Ultrasound for Regional Anesthesia (URSA). These websites are well-organized with highly accurate educational content; novice trainees can learn basic anatomy and clinical skills for UGRA from NYSORA and URSA [55][56][57][58][59][60][61]. We observed several common features in all videos; (1) the BSQS lacked the equipment preparation and post-procedure information and (2) there were very few comments (1.38 ± 3.15 (median: 0)).…”

Section: Discussionmentioning

confidence: 99%

Reliability and Quality of YouTube Videos on Ultrasound-Guided Brachial Plexus Block: A Programmatical Review

Cho

Park

et al. 2021

Healthcare

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Background: Ultrasound-guided regional anesthesia has gained popularity over the last decade. This study aimed to assess whether YouTube videos sufficiently serve as an adjunctive tool for learning how to perform an ultrasound-guided brachial plexus block (BPB). Methods: All YouTube videos were classified, based on their sources, as either academic, manufacturer, educational, or individual videos. The metrics, accuracy, utility, reliability (using the Journal of American Medical Association Score benchmark criteria (JAMAS)), and educational quality (using the Global Quality Score (GQS) and Brachial Plexus Block Specific Quality Score (BSQS)) were validated. Results: Here, 175 videos were included. Academic (1.19 ± 0.62, mean ± standard deviation), manufacturer (1.17 ± 0.71), and educational videos (1.15 ± 0.76) had better JAMAS accuracy and reliability than individual videos (0.26 ± 0.67) (p < 0.001). Manufacturer (11.22 ± 1.63) and educational videos (10.33 ± 3.34) had a higher BSQS than individual videos (7.32 ± 4.20) (p < 0.001). All sources weakly addressed the equipment preparation and post-procedure questions after BSQS analysis. Conclusions: The reliability and quality of ultrasound-guided BPB videos differ depending on their source. As YouTube is a useful educational platform for learners and teachers, global societies of regional anesthesiologists should set a standard for videos.

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“…The current guideline for anesthesia in COVID-positive patients is to minimize aerosolization. 14 , 16 Fortunately, many hand and upper extremity procedures can be performed under local or regional anesthesia augmented with sedation, obviating the need for general anesthesia (GA) 17 , 18 . This minimizes the risk of COVID-19 aerosolization from intubation.…”

Section: Anesthesiamentioning

confidence: 99%

Emergency Hand and Reconstructive Microsurgery in the COVID-19–Positive Patient

De¹,

Liang²,

Cheah³

et al. 2020

The Journal of Hand Surgery

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The case spectrum in hand surgery is one of extremes—purely elective day surgery cases under local anesthesia to mangling limb injuries that require immediate, and frequently, lengthy, surgery. Despite the cancellation of most elective orthopedic and plastic surgical procedures, hand surgeons around the world continue to see a steady stream of limb-threatening cases such as severe trauma and infections that require emergent surgical care. With the increase in community-spread, an increasing number of COVID-19–infected patients may be asymptomatic or have mild, nonspecific or atypical symptoms. Some of them may already have an ongoing, severe infection. The time-sensitive nature of some of these cases means that hand surgeons may need to operate urgently on patients who may be suspected of COVID-19 infections, often before confirmatory test results are available. General guidelines for perioperative care of the COVID-19–positive patient have been published. However, our practices differ from those of general orthopedic and plastic surgery, primarily because of the focus on trauma. This article discusses the perioperative and technical considerations that are essential to manage the COVID-19 patient requiring emergency care, without compromising clinical outcomes and while ensuring the safety of the attending staff.

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Upper extremity regional anesthesia techniques: A comprehensive review for clinical anesthesiologists

Cited by 18 publications

References 34 publications

Optimal concentration of ropivacaine for brachial plexus blocks in adult patients undergoing upper limb surgeries: a systematic review and meta-analysis

Optimal concentration of ropivacaine for brachial plexus blocks in adult patients undergoing upper limb surgeries: a systematic review and meta-analysis

Reliability and Quality of YouTube Videos on Ultrasound-Guided Brachial Plexus Block: A Programmatical Review

Emergency Hand and Reconstructive Microsurgery in the COVID-19–Positive Patient

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