Retrospective Single‐Center Comparative Analysis of Ultrasound‐Guided Versus Non‐ultrasound‐Guided Nerve Blocks in Extremity Surgeries

Zhang, Jianfeng; Zhang, Li; Li, Yong; Huo, Yongxin; Wang, Hui; Wang, Lei; Wang, Bao-Cang

doi:10.1002/jum.15747

Cited by 3 publications

(4 citation statements)

References 22 publications

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“…There was no difference in the rate of urinary retention complications between the two groups. These findings are consistent with previous studies [ 32 ], which have also demonstrated the safety and efficacy of ultrasound-guided PNB anesthesia in reducing postoperative complications.…”

Section: Discussionsupporting

confidence: 93%

Effect of peripheral nerve block versus general anesthesia on the hemodynamics and prognosis of diabetic patients undergoing diabetic foot Surgery

Zhu,

Xu,

Dai

et al. 2023

Diabetol Metab Syndr

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Background Diabetic foot ulcers (DFUs) represent a significant foot-related concern for patients with multiple co-morbidities, and surgical intervention is often employed. Notably, peripheral nerve block anesthesia (PNB) has emerged as a new approach for the surgical management of DFUs, providing sustained hemodynamic stability and superior postoperative pain control compared to general anesthesia (GEA). Methods The present study utilized a retrospective analysis of hospitalized patients who met the inclusion criteria for DFUs over a period of 7 years. Patients were categorized into two groups based on the type of anesthesia employed during the procedure: GEA or PNB. Extensive patient information was gathered and analyzed, such as demographics, intraoperative hemodynamic parameters, numeric rating scale (NRS) scores, and healing outcomes. The preliminary results assessed in this study were intraoperative hemodynamic stability and postoperative analgesic efficacy. Results During the study period, 117 patients received surgical therapy based on GEA, while 145 patients received PNB. Notably, the mean intraoperative blood pressure was significantly lower in the GEA group, and this difference remained statistically significant even after Bonferroni adjustment using linear mixed models. Additionally, the frequency of hypotensive episodes was higher in the GEA group (P < 0.05). Furthermore, the perioperative transfusion volume, overall intraoperative fluid input, and intraoperative bleeding volume were significantly more significant in the GEA group than in the PNB group. The postoperative pain NRS scores differed considerably between the two groups (Bonferroni corrected P < 0.01), with the GEA group exhibiting higher opioid consumption on the day of surgery and the first postoperative day when using patient-controlled intravenous analgesia (PCIA). Supplemental analgesic medication was more significant in the GEA group 24 h postoperatively. However, the two groups had no difference in hospital stay or treatment outcomes. There was no difference between the two groups regarding secondary surgery and amputation procedures. Although the 5-year mortality rate is 30.5%, no significant difference in mortality rates between the two groups was observed. Conclusions Compared to GEA, PNB is a safe and effective alternative therapy for managing DFUs. Our findings suggest that PNB administration during surgical intervention for this condition results in more stable intraoperative hemodynamics and superior postoperative analgesic effects, despite no significant difference in overall treatment outcomes between the two groups. The two groups did not differ in re-surgery, amputation, or 5-year mortality.

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Section: Discussionsupporting

confidence: 93%

Effect of peripheral nerve block versus general anesthesia on the hemodynamics and prognosis of diabetic patients undergoing diabetic foot Surgery

Zhu,

Xu,

Dai

et al. 2023

Diabetol Metab Syndr

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“…Tibial and foot surgeries, often complex and intricate, require effective postoperative pain management to enhance patient recovery and satisfaction. The challenges in managing postoperative wound pain in these surgeries are significant due to the complex nerve supply and the need for early mobilization 25,26 . Sciatic nerve block has emerged as a crucial technique in managing postoperative wound pain for lower limb surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…The challenges in managing postoperative wound pain in these surgeries are significant due to the complex nerve supply and the need for early mobilization. 25 , 26 Sciatic nerve block has emerged as a crucial technique in managing postoperative wound pain for lower limb surgeries. Its effectiveness in providing significant pain relief, reducing the need for systemic analgesics and facilitating early rehabilitation activities makes it an invaluable component in postoperative care.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the impact of ultrasound‐guided subsheath versus extrasheath sciatic nerve block on postoperative wound pain in tibial and foot surgeries: A systematic review and meta‐analysis

Yu,

Wang,

Jiang

et al. 2023

International Wound Journal

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This systematic review and meta‐analysis evaluate the impact of ultrasound‐guided subsheath versus extrasheath sciatic nerve blocks on postoperative wound pain in tibial and foot surgeries, crucial for effective pain management and patient recovery. Adhering to PRISMA guidelines, this study used a PICO framework, focusing on patients undergoing tibial and foot surgeries and comparing the efficacy and safety of subsheath and extrasheath sciatic nerve blocks. The literature search spanned four databases without time restrictions, assessing various outcomes like success rate, onset time, duration of analgesia and complication rates. Quality assessment employed the Cochrane Collaboration's risk of bias tool, and statistical analyses included heterogeneity assessment, fixed‐effect and random‐effects models, sensitivity analysis and publication bias evaluation using funnel plots and Egger's linear regression test. From an initial pool of 1213 articles, six met the inclusion criteria. The subsheath group showed a significantly higher success rate of complete sensory blockade within 30 min compared with the extrasheath group (OR = 5.39; 95% CI: 2.82–10.28; p < 0.01). No significant differences were found in procedure duration or incidence of nerve‐related complications between the two techniques. The subsheath approach also demonstrated a quicker onset time of sensory blockade (MD = −8.57; 95% CI: −11.27 to −5.88; p < 0.01). Sensitivity analysis confirmed the stability of the results, and no significant publication bias was detected. Ultrasound‐guided subsheath sciatic nerve blocks are more effective than extrasheath blocks in achieving rapid and complete sensory blockade for tibial and foot surgeries, with a quicker onset time and comparable safety profile. Subsheath injections are thus recommended as a preferred method for anaesthesia and postoperative pain management in these surgical procedures, enhancing overall patient outcomes.

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“…Literature has shown this to be particularly beneficial for invasive bedside procedures, including central venous catheterization, arterial catheterization, thoracentesis, paracentesis, lumbar puncture, and many others. 1 – 4 Using ultrasound at the bedside helps with both pre-procedural planning (static) as well as real-time guidance (dynamic) during a procedure. 5 Ultrasound is used to identify relevant anatomy, identify any obstructing structures in the way, identify any underlying contraindications to using a location and measuring distance from skin to target structure as static assessments.…”

Section: Introductionmentioning

confidence: 99%

Asynchronous training for ultrasound-guided peripheral IV placement among critical care nurses

et al. 2022

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Objective: Teaching ultrasound (US) guidance for placement of peripheral intravenous (PIV) catheters requires significant time for synchronous didactic and hands-on training. The investigators assessed the feasibility of an asynchronous model for critical care nurses to learn the novel skill of US-guided PIV placement. Secondary outcomes included the percentage of successful attempts and number of sticks per attempt for anatomy versus US-guided approaches. Methods: The investigators built a self-contained training cart for learners to practice and record their performance. Training occurred asynchronously. The learners recorded data from PIV attempts. Participants completed pre- and post-training surveys. Data from this prospective observational cohort was analyzed for descriptive and comparative statistics, using Kirkpatrick’s Model for evaluation of this educational intervention. Results: During a 6 month period, 21 nurses completed the asynchronous training, with eight recording their PIV placements. 81.0% of the training occurred outside of a Monday to Friday 9AM–5PM period. There were 64 attempts by anatomy approach and 84 with US-guidance. The anatomic approach was successful in 35.9% of attempts with a mean of 1.5 sticks (SD 1.0, Range 1–5). The US-guided approach had a statistically significant greater rate of success (77.4%; p < 0.001) with a mean of 1.2 sticks (SD 1.2, range 1–2, p < 0.01). Participants reported increased confidence in US-guided PIV placement and enjoyment with this method of learning. Conclusions: Asynchronous learning model with cart-based instruction and practice is a feasible means for nurses to learn US-guided PIV placement. Significant outcomes were seen across Kirkpatrick levels I–IV for educational outcome assessment.

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Retrospective Single‐Center Comparative Analysis of Ultrasound‐Guided Versus Non‐ultrasound‐Guided Nerve Blocks in Extremity Surgeries

Cited by 3 publications

References 22 publications

Effect of peripheral nerve block versus general anesthesia on the hemodynamics and prognosis of diabetic patients undergoing diabetic foot Surgery

Effect of peripheral nerve block versus general anesthesia on the hemodynamics and prognosis of diabetic patients undergoing diabetic foot Surgery

Evaluating the impact of ultrasound‐guided subsheath versus extrasheath sciatic nerve block on postoperative wound pain in tibial and foot surgeries: A systematic review and meta‐analysis

Asynchronous training for ultrasound-guided peripheral IV placement among critical care nurses

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