Background:Infraclavicular approach to the brachial plexus sheath provides anesthesia for surgery on the distal arm, elbow, forearm, wrist, and hand. It has been found that evoked distal motor response or radial nerve-type motor response has influenced the success rate of single-injection infraclavicular brachial plexus block.Aim:We conducted this study to compare the extent and effectiveness of infraclavicular brachial plexus block achieved by injecting a local anesthetic drug after finding specific muscle action due to neural stimulator guided posterior cord stimulation and lateral cord/medial cord stimulation.Methods:After ethical committee approval, patients were randomly assigned to one of the two study groups of 30 patients each. In group 1, posterior cord stimulation was used and in group 2 lateral/medial cord stimulation was used for infraclavicular brachial plexus block. The extent of motor block and effectiveness of sensory block were assessed.Results:All four motor nerves that were selected for the extent of block were blocked in 23 cases (76.7%) in group 1 and in 15 cases (50.0%) in group 2 (P:0.032). The two groups did not differ significantly in the number of cases in which 0, 1, 2, and 3 nerves were blocked (P>0.05). In group 1, significantly lesser number of patients had pain on surgical manipulation compared with patients of group 2 (P:0.037).Conclusion:Stimulating the posterior cord guided by a nerve stimulator before local anesthetic injection is associated with greater extent of block (in the number of motor nerves blocked) and effectiveness of block (in reporting no pain during the surgery) than stimulation of either the lateral or medial cord.
With improving healthcare facilities, the geriatric population in India is on the rise. Anaesthesia in the geriatric age group poses many challenges to the peri-operative physician because of the decreased functional reserve and various comorbidities associated with advanced age. In addition to that, there is greater risk of post-operative cognitive dysfunction and delirium. Anaesthesia in patients above 100 years is a sub-speciality in itself, with several special considerations. We, hereby present the case of a 102-year-old female patient with severe aortic stenosis posted for left-sided dynamic hip screw fixation on an emergency basis under low dose, unilateral spinal anaesthesia, supplemented with slow and graded epidural anaesthesia.
Introduction: Three-in-one block and Fascia Illiaca Compartment Block (FICB) are two peripheral nerve block techniques that target the femoral nerve, obturator nerve and lateral femoral cutaneous nerve in a single injection. Both nerve blocks are used to provide anaesthesia and analgesia to the lower limb for various surgical procedures. The use of ultrasonography in peripheral nerve blocks helps to visualise the nerve, needle, and the distribution of the drug in real-time. It, thus, shortens the time of onset of sensory block, decreases performance time, and lowers the required drug doses, and finally increases chances of a favourable outcome from the nerve block. Aim: To compare the postoperative analgesic efficiency of ultrasound-guided 3-in-1 block with FICB in patients undergoing lower limb orthopaedic surgeries under General Anaesthesia (GA). Materials and Methods: A randomised clinical study was conducted at a tertiary care hospital. One hundred and fifty patients were randomly allocated to two groups, 3-in-1 block group or FICB. Both groups received the respective blocks after surgery before extubation. Postoperatively, Visual Analog Scale (VAS) scores were evaluated hourly for first 6 hours and 2 hourly thereafter until rescue analgesia was instituted. Time period from giving the block to giving rescue analgesia was noted as duration of analgesia. Injection diclofenac 1.5 mg/kg Intravenous (IV) was given when VAS value reached ≥4. Results: On analysis of 150 patients, divided into 3-in-1 block group (N=75) and FICB Group(N=75); mean age: 53.29±8.69 years; the VAS scores at 2 to 18 hours, 20 hours, and 22 hours after performing the blocks were significantly less in the 3-in-1 block group compared to FICB group. Also, the mean time (hours) for first rescue analgesia in FICB group (3.49±0.53) was earlier compared with 3-in-1 block group (7.35±0.51). Conclusion: A 3-in-1 block provides effective and prolonged postoperative analgesia in comparison to FICB.
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