Combined ultrasound and nerve stimulator-guided deep nerve block may decrease the rate of local anesthetics systemic toxicity: a randomized clinical trial

Abstract

Background Ultrasound guidance might decrease the incidence of local anesthetics systemic toxicity (LAST) for many peripheral nerve blocks compared with nerve stimulator guidance. However, it remains uncertain whether ultrasound guidance is superior to nerve stimulator guidance for deep nerve block of the lower extremity. This study was designed to investigate whether deep nerve block with ultrasound guidance would decrease the incidence of LAST compared with that with nerve stimulator guidance, and to identify associated risk factors of LAST. Methods Three hundred patients undergoing elective lower limb surgery and desiring lumbar plexus blocks (LPBs) and sciatic nerve blocks (SNBs) were enrolled in this study. The patients were randomly assigned to receive LPBs and SNBs with ultrasound guidance (group U), nerve stimulator guidance (group N) or dual guidance (group M). The primary outcome was the incidence of LAST. The secondary outcomes were the number of needle redirection, motor and sensory block onset and nerve distribution restoration time, as well as associated risk factors. Results There were 18 patients with LAST, including 12 in group U, 4 in group N and 2 in group M. By multiple comparisons among the three groups, we found that the incidence of LAST in group U (12%) was significantly higher than that in group N (4%)( P = 0.037) and group M(2%)( P = 0.006). The OR of LAST with hepatitis B (HBV) infection and the female sex was 3.352 (95% CI,1.233–9.108, P = 0.013) and 9.488 (95% CI,2.142–42.093, P = 0.0004), respectively. Conclusions Ultrasound guidance, HBV infection and the female sex were risk factors of LAST with LPBs and SNBs. For patients infected with HBV or female patients receiving LPBs and SNBs, we recommended that combined ultrasound and nerve stimulator guidance should be used to improve the safety. Trial registration This study was approved by the Ethical Committee of the First Affiliated Hospital of Army Medical University. The protocol was registered prospectively with the Chinese Clinical Trial Registry ( ChiCTR-IOR-16008099 ) on March 15, 2016.

Wavelet Transform-Based Ultrasound Image Enhancement Algorithm for Guided Gynecological Laparoscopy Imaging of Local Anesthetics in Perioperative Gynecological Laparoscopy

“…e results showed that the VAS scores and PONV scores of patients with TAP block decreased evidently at 3 h, 6 h, and 12 h after surgery, and the number of patients who used tramadol for analgesic remedy after surgery was reduced, which greatly improved patient satisfaction. e results were consistent with those of Zhang et al [14].…”

“…erefore, TAP block requires the adoption of appropriate drug concentration and dosage [14]. In this work, 20 mL of 0.375% ropivacaine was used to observe the block plane distribution between the two groups within 30 minutes after the TAP block, and the difference was not considerable (P < 0.05).…”

An uncommon cause of nerve stimulator’s malfunction during a dual guidance lumbar plexus block: A technical brief report and an algorithm for prevention of complications

“…Combining ultrasound guidance and nerve stimulation may be helpful to safely confirm lumbar plexus sonoanatomy, and to place the tip of the needle just close to the targeted nerve. The dual guidance aims to decrease the incidence LAST and/or nerve injury, particularly while performing a deep nerve block such as a PLPB 11 . A nerve stimulator malfunction or an electrical disconnection may occur during the nerve block procedure 12,13 .…”

Bibliometric evaluation of ultrasound in orthopaedics&nbsp;global publications: 10-year trends and&nbsp;hotspots

“…Therefore, epidemiological factors such as gender and age have gradually drawn attention in a large number of clinical studies, and gender is one of the important in uencing factors in the diagnostic models and prognostic analysis models of some diseases. For example, in a study of combined ultrasound and nerve stimulator-guided deep nerve block, the research objects were also grouped by sex (40). Similarly, in a study of risk factors for osteoporosis and associated fractures, females have long been listed as a risk factor, and due to the secretion of female oestrogen, it has also become a point of consideration in the treatment of osteoporosis patients (41).…”