Ultrasound-guided supraclavicular block is associated with a high rate of successful surgical anesthesia and a low rate of complications and thus may be a safe alternative for both inpatients and outpatients. Severe underlying respiratory disease and coagulopathy should remain a contraindication for this brachial plexus approach.

Purpose: Ultrasound (US) is being used increasingly to guide needle placement during axillary brachial plexus blockade (AXB). This retrospective study investigated whether US guidance can increase the success rate, decrease block onset time, and reduce local anesthetic (LA) volume for AXB compared to a traditional (TRAD) approach, namely, peripheral nerve stimulation (PNS) and transarterial (TA) techniques. Methods:The anesthetic records, operative reports, discharge summaries, and surgical consultation notes of all patients who had undergone AXB for surgical anesthesia at the Toronto Western Hospital, between October 2003 and November 2006 were, retrospectively reviewed for evidence of block success and associated complications. Block success was defined as the achievement of surgical anesthesia without additional LA supplementation.Results: Among the 662 patients, 535 patients underwent AXB using US guidance (US group), and 127 using TRAD techniques (TRAD group), namely, 56 using PNS (PNS subgroup) and 71 using the TA technique (TA subgroup). The block success rate was higher in the US group compared to the TRAD group (91.6% vs 81.9%, p = 0.003). The LA volume used for AXB was less in the US group compared to the TRAD group (39.8 ± 6.4 mL vs 46.7 ± 17.1 mL, p < 0.0001). Ultrasound group patients spent less time in the block procedure room than those in the TRAD group (30.6 ± 14.2 min vs 40.1 ± 27.3 min, p < 0.0001). When analyzed by subgroup, the US group demonstrated significantly greater success and shorter duration in the block room compared to the PNS subgroup, but not the TA subgroup. Complications (inadvertent intravenous LA injection, and transient neuropathy) were lower in the US group compared to the TRAD group (0.37% vs 3.15%, p = 0.014). Conclusions:Our results suggest that US-guided AXB may improve block success, reduce the local anesthetic volume used, and shorten the time spent in the block room compared to traditional nerve localization techniques.

BACKGROUND Tranexamic acid (TXA) therapy is effective in reducing postoperative red blood cell (RBC) transfusion in total joint arthroplasty (TJA), yet uncertainty persists regarding comparative efficacy and safety among specific patient subgroups. We assessed the impact of a universal TXA protocol on RBC transfusion, postoperative hemoglobin (Hb), and adverse outcomes to determine whether TXA is safe and effective in TJA, both overall and in clinically relevant subgroups. STUDY DESIGN AND METHODS A retrospective observational study was performed on patients undergoing TJA at our institution spanning 1 year before and after the implementation of a universal protocol to administer intravenous (IV) TXA. The primary outcome was percentage of patients transfused, and secondary outcomes were perioperative Hb and occurrence of adverse events (death, myocardial infarction, stroke, seizure, pulmonary embolism, deep vein thrombosis, and acute kidney injury ). Outcomes were compared in pre‐ and post‐protocol groups with χ2 analysis. Logistic regression compared risk of transfusion in pre‐ and post‐protocol subgroups of patients with differing risk for transfusion (anemia, body mass index [BMI], and sex). RESULTS No differences were found in baseline patient characteristics across pre‐ and post‐protocol groups (n = 1084 and 912, respectively). TXA use increased from 32.3% to 92.2% while transfusion rates decreased from 10.3% to 4.8% (p < 0.001). Postoperative Day 3 Hb increased from 95.8 to 101.4 g/L (p < 0.001). Logistic regression demonstrated reduced transfusion in post‐protocol subgroups regardless of sex, anemia, or BMI (p < 0.001). No increase in adverse events was observed (p = 0.8451). CONCLUSIONS Universal TXA was associated with a reduction of RBC transfusion, overall and in clinically relevant subgroups, strengthening the rationale for universal therapy.

No abstract

No abstract

No abstract

No abstract

No abstract