Chart Review of PACU Outcomes for Patients Who Had Ambulatory Shoulder Surgery with Peripheral Nerve Block (PNB) and General Anesthesia Compared to General Anesthesia (GA)

Feierman, Dennis E.; Klinkowitz, Eliezer; Keilin, Charles A.; Kronenfeld, Mark; Rahmani, David; Saberito, Darlene; Gupta, Puneet

doi:10.4236/ojanes.2015.57031

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…Moreover, the use of peripheral nerve blocks reduces the use of post-op narcotics, which may be related to the lower use of postoperative antiemetic drugs observed. 13 Opioids are the most frequently used local anesthetic adjuvants. The use of these drugs in neuraxial blocks has evolved over the last 50 years.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Guided Infraclavicular Block for Pain Control After Upper Extremity Surgery

Yalçın¹,

Arı

Köksal

et al. 2018

Hosp Pract Res

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Background: Opioids added to local anesthetics for peripheral nerve blocks may intensify analgesia and prolong analgesic and sensorial block duration. These agents may also cause potentiation and prolongation of motor block. Objective: This study compared the postoperative effects of 30 mL of 0.25% bupivacaine +50 mcg fentanyl and 30 mL of 0.25% bupivacaine + 100 mcg fentanyl solutions for the ultrasound-guided infraclavicular block in patients undergoing elbow and forearm surgery. Methods: In this randomized double-blind study, thirty-six patients with risk of ASA class I-III were randomly allocated into 2 randomized groups. Ultrasound-guided infraclavicular blocks with 30 mL of 0.25% bupivacaine + 50 mcg fentanyl for group 1 and 30 mL of 0.25% bupivacaine + 100 mcg fentanyl for group 2 were performed before patients emerged from general anesthesia. After surgery, pain levels at rest and during movement were evaluated using the 10-cm visual analog scale (VAS) at recovery room admission, at the 15th and 30th minutes in the recovery room, and at the 2nd, 6th, 12th and 24th hours postoperatively. Both morphine and rescue analgesic requirements were recorded. Sensorial and motor block durations, patient satisfaction, and complications related to the infraclavicular block were recorded. Results: In both groups, no significant difference in VAS pain scores, total morphine and total rescue analgesic requirements, duration of sensorial and motor block, or patient satisfaction were observed. None of the patients experienced any complications. Conclusion: The mixtures of 0.25% bupivacaine + 50 mcg fentanyl and 0.25% bupivacaine + 100 mcg fentanyl showed similar postoperative effects.

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Section: Discussionmentioning

confidence: 99%

Ultrasound Guided Infraclavicular Block for Pain Control After Upper Extremity Surgery

Yalçın¹,

Arı

Köksal

et al. 2018

Hosp Pract Res

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Randomized Trial of the Use of Dexmedetomidine vs. Propofol after Regional Blockade in Shoulder Surgery Patients in Beach Chair Position

Gupta¹,

Wellisch²,

Kronenfeld³

et al. 2015

OJAnes

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Background: Propofol is often the drug of choice for ambulatory orthopedic cases. However, propofol can be associated with apnea or other events requiring airway interventions. Dexmedetomidine (Dex) has the unique pharmacologic profile of providing sedation without respiratory depression. This is particularly relevant in patients with morbid obesity and/or challenging airways. The hypotheses were: 1) Propofol would cause more apnea or require more airway manipulations than dexmedetomidine; 2) Propofol would have shorter post anesthesia unit recovery times; and 3) Dexmedetomidine would be associated with more bradycardia and hypotension. Methods: After IRB approval, 50 patients were randomized to receive either propofol or Dex for Total Intravenous anesthesia (TIVA) after interscalene brachial plexus block was performed preoperatively under ultrasound guidance. The main end points that we measured where: airway interventions, intra-operative bradycardia, hypotension, and PACU length of stay. Results: There were more airway interventions in the propofol group compared to the Dex group. Additionally, the Dex group had significantly longer PACU stays. Conclusion: We would recommend that Dex should be preferentially considered for patients predisposed to airway obstruction; however, the standard use of Dex over Propofol needed to reconsider since the use of Dex as the agent for TIVA was associated with longer PACU stays.

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Chart Review of PACU Outcomes for Patients Who Had Ambulatory Shoulder Surgery with Peripheral Nerve Block (PNB) and General Anesthesia Compared to General Anesthesia (GA)

Cited by 2 publications

References 6 publications

Ultrasound Guided Infraclavicular Block for Pain Control After Upper Extremity Surgery

Ultrasound Guided Infraclavicular Block for Pain Control After Upper Extremity Surgery

Randomized Trial of the Use of Dexmedetomidine vs. Propofol after Regional Blockade in Shoulder Surgery Patients in Beach Chair Position

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