Ultrasound-guided nerve blocks: efficacy and safety

Warman, Paul; Nicholls, Barry

doi:10.1016/j.bpa.2009.02.004

Cited by 40 publications

(19 citation statements)

References 68 publications

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“…Although there is no clear evidence that ultrasound guided blocks prevent complications, visualization of the anatomical structures with ultrasound should allow more accurate delivery of the local anesthetic solution as well as allowing an adequate block with lower local anesthetic volumes. [181920] Although we accept that an ultrasound guided block in a small infant may be viewed with concern, the simplicity of the technique allows aptitude to be rapidly gained. Local infiltration required an average dose of 0.8 ml/kg of 2.5 mg/kg L-bupivacaine.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound guided rectus sheath blockade compared to peri-operative local anesthetic infiltration in infants undergoing supraumbilical pyloromyotomy

2014

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Background:Provision of appropriate analgesia for supraumbilical pyloromyotomy in infants is limited by concerns about sensitivity to opioids and other medication groups, due to immature metabolism. Local anesthetic infiltration and ultrasound guided rectus sheath blockade are two techniques commonly employed to provide perioperative analgesia. The aim of this review was to compare the quality of post-operative analgesia afforded by these two techniques.Materials and Methods:A retrospective chart analysis of hospital records of all patients who underwent supraumbilical pyloromyotomy at a tertiary pediatric hospital between March 2009 and February 2011. Analysis of the anesthetic technique employed and post-operative acetaminophen requirements were performed. Additional information as to time to first post-operative feed, any complications and time of discharge from the hospital were collected by reviewing the post-operative nursing notes.Results:A total of 30 patients underwent supraumbilical pyloromyotomy during this period. A total of 18 received local anesthetic infiltration at the end of the procedure and 12 patients underwent ultrasound guided pre-incisional rectus sheath block for post-operative analgesia. Patients who had post-operative local anesthetic infiltration had a median (range) of 2 (1-3) doses of acetaminophen in the first 24 h. In the group of patients who received a rectus sheath block, the median (range) number of doses of acetaminophen in the first 24 h was also 2 (1-3). There were no differences in time to first feed and time to hospital discharge between the groups. The volume of local anesthetic administered was significantly smaller in the group receiving analgesia via rectus sheath block.Conclusion:Local anesthetic infiltration and pre-incisional ultrasound guided rectus sheath block provide similar degrees of post-operative analgesia. There were no differences between the two groups in time for first post-operative feed and time to hospital discharge.

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Section: Discussionmentioning

confidence: 99%

Ultrasound guided rectus sheath blockade compared to peri-operative local anesthetic infiltration in infants undergoing supraumbilical pyloromyotomy

2014

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“…This has reduced the chances of local anaesthesia systemic toxicity (LAST) as injections are given under direct vision and in real time with an overall lesser volume of LA. The plexus blocks (interscalene, supraclavicular, infraclavicular, axillary) and femoral nerve blocks are given by direct visualization of neural structures on USG [8]. The volume of LA required for these blocks with the use of USG has reduced signifi cantly.…”

Section: Comparative Toxicitymentioning

confidence: 99%

Local Anaesthetic Myotoxicity Due to Fascial Plane Blocks: A Brief Review

Nair¹

2017

Glob J Anesth

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Fascial plane blocks have become quite popular in the present practice of regional anaesthesia. Transverses abdominal plane (TAP) block, quadratus lumborum (QL), serratus anterior plane (SAP) block, pectoralis block (PECS 1/ 2), rectus sheath and adductor canal block are quite easy to perform with ultrasonographic (USG) guidance. The anaesthesiologist identifi es the muscles and the relevant fascial plane to inject the local anaesthetic (LA) in the desired plane under USG guidance. Current prospective and observational studies have shown that these are quite effective as a single injection and can be used for continuous analgesia with an indwelling catheter in the fascial plane. All fascial plane blocks are transmuscular injections i.e. the needle has to reach the target plane by piercing the adjoining muscles. There are high chances of LA injection in the muscle or spillage of LA in the substance of muscle especially after high volume LA injections. The possibility is more when an anaesthesiologist has recently learnt a fascial plane block and is applying it in clinical practice. The myotoxicity could be more profound in continuous LA infusions where the muscle will get continuously exposed to LA.

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“…Complications from femoral nerve blockade are infrequent and are likely decreased with the utilization of point-of-care ultrasound needle guidance. 18,[21][22][23] Needle insertion using the in-plane technique may be superior to "out-of-plane" technique because it allows for improved visualization of the needle tip, avoiding inadvertent injection into the femoral nerve as well as allowing for localization of anesthetic around the target nerve. 2,21,24 Hematoma formation may result from vascular puncture or from bleeding if lymph nodes are penetrated.…”

Section: Pitfall and Complicationmentioning

confidence: 99%

Ultrasound-Guided Femoral Nerve Blocks

Baker

Gullett

2015

Pediatric Emergency Care

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Pediatric acute femur fractures are a relatively common major orthopedic injury seen in emergency departments. Providing adequate and safe analgesia is essential while patients await definitive management of these fractures. Opioid medications are typically used to treat fracture-associated pain but have well-known adverse effects including respiratory and central nervous system depression, pruritus, nausea, and allergic reactions. Dose titration of opioids in pediatric patients may be difficult and requires frequent nursing and physician reassessments. Regional anesthesia using ultrasound guidance has been proposed as a reliable and safe method to provide pain relief for this population and to decrease reliance on opioid medications. There is a growing body of literature on the utility and safety of ultrasound-guided femoral nerve blocks for pediatric patients in the acute care setting. This review article covers recent literature on point-of-care ultrasound-guided femoral nerve blocks for pediatric patients, with a discussion of the indications, sonographic anatomy, selection of anesthetics, nerve block technique, and complications. This review supplements the expert supervision and practice required to gain competency.

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Ultrasound-guided nerve blocks: efficacy and safety

Cited by 40 publications

References 68 publications

Ultrasound guided rectus sheath blockade compared to peri-operative local anesthetic infiltration in infants undergoing supraumbilical pyloromyotomy

Ultrasound guided rectus sheath blockade compared to peri-operative local anesthetic infiltration in infants undergoing supraumbilical pyloromyotomy

Local Anaesthetic Myotoxicity Due to Fascial Plane Blocks: A Brief Review

Ultrasound-Guided Femoral Nerve Blocks

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