Physiological and pharmacologic aspects of peripheral nerve blocks

Vadhanan, Prasanna; Tripaty, Debendra Kumar; Adinarayanan, S

doi:10.4103/0970-9185.161679

Cited by 44 publications

(28 citation statements)

References 78 publications

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“…Thereby, the patients were randomly divided into two groups; the first Group (M) received 4 mg/kg lidocaine 1% (Aburaihan Co., Iran) plus 50 micg fentanyl plus 5 mL magnesium sulfate 20% (Pasteur Institute, Iran), and the second group (N) received 4 mg/kg lidocaine 1% plus 50 micg fentanyl plus 5 mL normal saline 0.9%. The dose of magnesium sulfate was determined based on previous studies ( 1 , 12 ). The nurse of operation room prepared the drug components.…”

Section: Methodsmentioning

confidence: 99%

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The Effect of Magnesium Sulfate on Postoperative Pain in Upper Limb Surgeries by Supraclavicular Block Under Ultrasound Guidance

et al. 2017

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BackgroundPrevious studies have been conducted to evaluate the effect of different adjuvants on brachial plexus block.ObjectivesThis study investigated the effect of adding magnesium sulfate to lidocaine on postoperative pain in upper limb surgeries by supraclavicular brachial plexus block under ultrasound guidance.MethodsThis study was carried out on patients who were candidate for upper limb surgeries. This was a controlled double-blind study conducted on a number of 52 patients aged 18 - 75 years with ASA class I or II. The first group (M) received lidocaine 1% (4 mg/kg) plus fentanyl 50 micg and magnesium sulfate 20% (5 mL) while the second group (N) received lidocaine 1% (4 mg/kg) plus fentanyl 50 micg and normal saline (5 mL) to supraclavicular brachial plexus block under ultrasound guidance. Postoperative pain was evaluated by visual analog scale (VAS) until 24 hours. Sensory and motor blocks onset and duration, rescue analgesics, hemodynamic variables, and side effects were recorded for all the patients.ResultsPostoperative VAS values at 24 hours were significantly lower in group M than group N (P < 0.0001). Sensory and Motor blocks onset and duration were statistically longer in group M than group N (P < 0.0001).ConclusionsThe addition of magnesium sulfate to lidocaine decreased the postoperative pain and increased the onset and duration of sensory and motor blocks in supraclavicular brachial plexus block under ultrasound guidance in upper limb surgeries.

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Section: Methodsmentioning

confidence: 99%

“…More recently, it has been shown that magnesium sulfate decreased the effects of aminoamide local anesthetics on rat sciatic nerves in vivo. Hence, based on this paradoxical data, currently magnesium cannot be recommended as an adjuvant to enhance nerve blocks and needs to further studies ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Magnesium Sulfate on Postoperative Pain in Upper Limb Surgeries by Supraclavicular Block Under Ultrasound Guidance

et al. 2017

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“…Zahvaljujući upotrebi ultrazvuka, kojim je omogućena vizuelizacija ne samo nervnih struktura nego i mesta davanja lokalnog anestetika, danas su definisane tri tehnike: intraneuralna, intrapleksus i peripleksus, i uveden je pojam minimalnog efektivnog volumena (MEV) i minimalne efektivne anestetičke koncentracije (MEAC). Pokazano je da je minimalni volumen za blokadu brahijanog pleksusa oko 32 ml, nezavisno od tehnike koja se koristi 64 . Ali pod kontrolom ultrazvuka blok je uspešan i samo sa 2 ml po nervu, kada je u pitanju mekotkivna hirurgija 65 .…”

Section: Diskusijaunclassified

Ultrasound and nerve stimulator guided peripheral nerve blocks of the upper and lower limbs

Srećković¹

2018

Serb J Anest Inten Therapy

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Sažetak Periferni nervni blokovi se kao anesteziološka tehnika koriste već decenijama u hirurgiji gornjih i donjih ekstremiUvod P eriferni nervni blokovi danas se koriste u hirurgiji gornjih i donjih ekstremiteta ne samo u cilju obezbeđivanja anestezije za hirurške procedure nego i kao dijagnostički, prognostički, preemptivni, a u poslednje vreme sve više i kao deo multimodalne analgezije 1 . Tome su doprinele brojne prednosti, uključujući pre svega minimalnu pripremu pacijenta, kardiorespiratornu stabilnost, koja je obezbeđena tokom hirurške intervencije, i smanjenje postoperativne mučnine i povraćanja u odnosu na centralnu sprovodnu anesteziju. Obezbeđujući značajnu kontrolu bola, doprineli su smanjenju potrošnje opioida u postoperativnom toku. Sve ovo je dovelo do rane rehabilitacije pacijenata, smanjivši broj bolničkih dana, kao i prevenciju ponovnog prijema, što je rezultiralo povećanim zadovoljstvom pacijenata, kao i smanjenjem ukupnih troškova lečenja [2][3][4][5][6][7][8][9] . Uvođenje nervnog stimulatora, a u poslednjih deset godina i ultrazvuka, doprinelo je promenama u svakodnevnoj praksi, omogućivši značajno širu primenu perifernih nervnih blokova, uz danas najviši stepen uspešnosti, ali i sigurnosti za pacijenta 1 . Nervnim stimulatorom se generiše električni impuls niskog inteziteta (do 5 mA), kratkog trajanja (0,05-1 ms) i frekvence (1-2 Hz), a kojim se dobija motorni ili senzorni odgovor nerva. U cilju što boljeg pozicioniranja igle, a bez kontakta sa nervom, preporučuje se jačina 0,2-0,3 mA, 0,1 ms, 2 Hz. Međutim, u poređenju sa nervnim stimulatorom, blokovi perifernih nerava vođeni ultrazvukom imaju određene prednosti, pre svega u kvalitetu bloka, količini upotrebljenog lokalnog anestetika, manjoj neprijatnosti za pacijenta, kao i manjoj učestalosti punkcije krvnog suda 10,11 . Da bi se omogućila vizuelizacija nervnih struktura, u zavisnosti od dubine, koriste se dve sonde: linearna (frekvence 5-18m Hz) za površne strukture do 6 cm i konveksna (frekvence 2,5-5 MHz) za dublje strukture 12 .

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“…In alkaline conditions, local anesthetics are predominantly uncharged which maximizes their permeability through the cellular lipid bilayer. Existence in an uncharged and highly permeable form is essential to the function of local anesthetics because they must bind to the cytoplasmic side of Nav channels [64]. Accordingly, local anesthetics are not generally used as an analgesic in conditions of acidic or inflammatory pain (e.g., rheumatoid arthritis) because protonation results in ionization, decreased permeability, and poor efficacy.…”

Section: Voltage-gated Sodium Channel Pharmacologymentioning

confidence: 99%

Pain transduction: a pharmacologic perspective

McEntire

Kirkpatrick

Dueck

et al. 2016

Expert Review of Clinical Pharmacology

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Pain represents a necessary physiological function yet remains a significant pathological process in humans across the world. The transduction of a nociceptive stimulus refers to the processes that turn a noxious stimulus into a transmissible neurological signal. This involves a number of ion channels that facilitate the conversion of nociceptive stimulus into an electrical signal. Because an understanding of nociceptive physiology complements a discussion of analgesic pharmacology, the relationships between the two are presented together. In this review article, a critical evaluation is provided on the findings relating to both the physiology and pharmacology of relevant acid-sensing ion channels (ASIC), and transient receptor potential (TRP) cation channels, and voltage-gated sodium (Nav) channels.

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Physiological and pharmacologic aspects of peripheral nerve blocks

Cited by 44 publications

References 78 publications

The Effect of Magnesium Sulfate on Postoperative Pain in Upper Limb Surgeries by Supraclavicular Block Under Ultrasound Guidance

The Effect of Magnesium Sulfate on Postoperative Pain in Upper Limb Surgeries by Supraclavicular Block Under Ultrasound Guidance

Ultrasound and nerve stimulator guided peripheral nerve blocks of the upper and lower limbs

Pain transduction: a pharmacologic perspective

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