Background:The supraclavicular approach is considered to be the easiest and most effective approach to block the brachial plexus for upper limb surgeries. The classical approach using the anatomical landmark technique was associated with higher failure rates and complications. Ultrasonography (USG) guidance and peripheral nerve stimulator (PNS) have improved the success rates and safety margin.Aims:The aim of the present study is to compare USG with PNS in supraclavicular brachial plexus block for upper limb surgeries with respect to the onset of motor and sensory blockade, total duration of blockade, procedure time, and complications.Settings and Design:Prospective, randomized controlled study.Subject and Methods:Sixty patients aged above 18 years scheduled for elective upper limb surgery were randomly allocated into two groups. Group A patients received supraclavicular brachial plexus block under ultrasound guidance and in Group B patients, PNS was used. In both groups, local anesthetic mixture consisting of 15 ml of 0.5% bupivacaine and 10 ml of 2% lignocaine with 1:200,000 adrenaline were used.Statistical Analysis:Independent t-test used to compare mean between groups; Chi-square test for categorical variables.Results:The procedure time was shorter with USG (11.57 ± 2.75 min) compared to PNS (21.73 ± 4.84). The onset time of sensory block (12.83 ± 3.64 min vs. 16 ± 3.57 min) and onset of motor block (23 ± 4.27 min vs. 27 ± 3.85 min) were significantly shorter in Group A compared to Group B (P < 0.05). The duration of sensory block was significantly prolonged in Group A (8.00 ± 0.891 h) compared to Group B (7.25 ± 1.418 h). None of the patients in either groups developed any complications.Conclusion:The ultrasound-guided supraclavicular brachial plexus block can be done quicker, with a faster onset of sensory and motor block compared to nerve stimulator technique.
Supraclavicular brachial plexus block is one of the preferred technique to provide perioperative anaesthesia and analgesia for upper limb surgical procedures. The duration of block can be extended by the addition of various adjuvants. Our aim is to compare the efficacy of dexamethasone and dexmedetomidine as an adjuvant to bupivacaine in extending the duration of supraclavicular brachial plexus block and also to compare the pain scores and postoperative morphine consumption. Materials and Methods: We randomised 90 patients scheduled for upper limb surgeries into three groups with each group consisting of 30 patients in this prospective randomized study. All patients in the three groups received 25 ml of 0.5% bupivacaine. Along with bupivacaine, Group A patients received 8 mg (2 ml) of Dexamethasone, 1µ gkg −1 (2ml) of dexmedetomidine in group B and 2 ml of normal saline in group C. Postoperatively, all patients received morphine by patient cont rolled analgesia (PCA) and the block characteristics, pain scores and total opioid consumption were noted. Results: We noted a significantly extended motor block (1303.93±2 33.71 min vs 888.62±57.92 min) and extended sensory block (1619.29 ±235.49 vs 1084.14±207.58 min) in dexamethasone group compared with the dexmedetomidine group. The postoperative pain scores and morphine consumption were comparable between the dexamethas one and dexmedetomidine groups. Conclusion: As an adjuvant to bupivacaine, dexamethasone significantly extends the duration of supraclavicular brachial plexus block compared to dexmedetomidine. Both the above two adjuvants are effective in decreasing the posto perative morphine consumption.
BackgroundAcute postoperative pain after breast cancer surgery adversely affects recovery and is an independent predictor of chronic postsurgical pain in these patients. Serratus plane blocks have been found to provide analgesia to the anterior hemithorax. However, trials comparing superficial serratus plane block and deep serratus block in breast cancer surgery patients are sparse.
MethodologyA total of 74 female patients with American Society of Anesthesiologists physical status I and II scheduled for elective modified radical mastectomy for breast cancer were randomized into two groups. Group A patients received a superficial serratus plane block with 30 mL of 0.25% bupivacaine, and group B patients received a deep serratus plane block with 30 mL of 0.25% bupivacaine. Postoperatively, the Numerical Rating Scale (NRS) score was measured during the immediate postoperative period, after 30 minutes and at one, four, eight, 16, and 24 hours, as well as on the second and third day. After discharge, the NRS scores were recorded in the second and third weeks and then monthly once for three months. All patients received patient-controlled analgesia with intravenous (IV) morphine. The duration of analgesia, pain scores, and 24hour morphine consumption were also noted.
ResultsIn group A, the mean duration of analgesia (hours) was 5.51 ± 1.42, whereas in group B the mean duration of analgesia (hours) was 6.69 ± 1.18 (p < 0.01). NRS scores for pain during rest at 12 and 16 hours and NRS scores for pain during cough at eight, 12, and 16 hours, as well as at the third month were significantly lower in group B. However, morphine consumption was comparable between the groups.
ConclusionsDeep serratus plane block was associated with better NRS scores for pain on rest and coughing and prolonged duration of analgesia after a modified radical mastectomy. We conclude that the deep serratus plane block provides superior and extended analgesia than the superficial serratus plane block after a modified radical mastectomy.
Left ventricular (LV) thrombus formation is a notorious complication encountered in postmyocardial infarction patients. Such cases, when coming for noncardiac surgery, put the patient at greater risk of embolic events. Anesthesiologists play a pivotal role in the management of such rare and difficult cases. There is sparse evidence on management of such cases for noncardiac surgery. Hence, we would like to share our experience of a young patient with LV thrombus posted for left decompressive craniectomy.
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