Ultrasound-guided peripheral nerve blocks in anticoagulated patients – case series

Martins, Luis Eduardo Silveira; Ferraro, Leonardo Henrique Cunha; Takeda, Alexandre; Munechika, Masashi; Tardelli, Maria Ângela

doi:10.1016/j.bjane.2015.06.005

Cited by 6 publications

(8 citation statements)

References 23 publications

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“…Thus, this block may be helpful for patients with renal failure or patients with a higher risk for postoperative acute kidney injury. 12 Advantages of brachial plexus block include prolonged analgesia, lower incidence of postoperative nausea and vomiting, and shorter in-hospital days. 7 However, it holds the risk for procedure-related complications such as accidental nerve injury and vascular puncture.…”

Section: Discussionmentioning

confidence: 99%

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Axilary Block Ultrasound Guiding in Patient with Pseudoaneurysm Regio Brachii Sinistra pro Repair Pseudoaneurysm

Purnomo

Kasmantino

2022

JAP

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Background: An aneurysm may be a true aneurysm or a pseudoaneurysm. Pseudoaneurysm is defined as a defect in the arterial wall, making a connection between the lumen and the extraluminal space. The main etiology of brachial artery pseudoaneurysm is incidental arterial puncture during venous cannulation for hemodialysis. Case:: Anesthetic management was performed on a female patient 56 years old, body weight 45 kg, height 150 cm. The patient had other comorbidities such as hypertension, diabetes mellitus, chronic renal kidney with a diagnosis of left brachial pseudoanuerysm. Pro Pseudoanurysm repair surgery. The anesthetic technique uses axillary peripheral nerve block with ultrasound guiding. The duration of surgery is ± 120 minutes. After the operation, the patient was treated in the hospital ward. Conclusion: Choosing the most appropriate anesthetic technique for patients with renal impairment is necessary to maintain normovolemia and normotension in order to avoid unexpected complications. Using regional anesthetic technique for sympathetic nerve block may be favorable in these patients. With ultrasound guiding, the incidence of failure is lower, the time required is shorter, the latency is shorter, the blockade is longer, and the risk of accidental vascular puncture is lower so that vascular lesions are less likely.

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Section: Discussionmentioning

confidence: 99%

“…A meta-analysis compared ultrasound-guided peripheral nerve blocks and conventional techniques (paresthesia and neurostimulation) showed a lower risk of accidental vascular puncture when ultrasound was used. 12…”

Section: Discussionmentioning

confidence: 99%

Axilary Block Ultrasound Guiding in Patient with Pseudoaneurysm Regio Brachii Sinistra pro Repair Pseudoaneurysm

Purnomo

Kasmantino

2022

JAP

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“…A meta-analysis that compared PNB using ultrasound guidance with classical techniques (paresthesia and neurostimulation) showed a lower occurrence of vascular punctures in cases of ultrasound guidance. 14 Therefore, most patients taking anticoagulants and/or antiplatelets are admitted for emergency surgery in the operating room. Stopping antiplatelet medication such as clopidogrel and aspirin can lead to complications.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Sciatic and Femoral Block in Patient with Recent Embolism Stroke Undergo Amputation Above the Knee

mubarak

2021

JAP

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Background: Patients undergoing amputation of the lower extremities usually have poor circulation and other comorbidities and, therefore, present a challenge to the anesthesiologist. The combination of sciatic and femoral nerve block is reported to be an effective anesthetic technique for patients undergoing knee surgery, and it is known to be an effective method of postoperative analgesia in patients undergoing major surgery on the subject's lower extremities. Case: A 70-year-old man with a recent embolism stroke, death of his limb on the right cruris region, and underwent an amputation above the knee. Preoperative physical examination showed GCS E4 V, motor aphasia M6, blood pressure 131/82 mmHg, pulse 114 bpm, RR 20 times/minute with bodyweight 70 kg, height 160 cm, SpO2 97%. There was cyanosis in the right cruric region with motor power of 1/5 1/5. The value of leukocytes 18,600/ul, platelets 309,000/ul, Prothrombin Time (PT) 15.8 seconds, Activated partial thromboplastin time (APTT) 25.9 seconds, International normalized ratio (INR) 1,330, neutrophils 81.7%, lymphocytes 12.6%, creatinine 1.8 mg/dl, urea 137 mg /dl, blood sugar at the time 258 mg/dl, Cl 95 mmol/l. This case report suggests that ultrasound-guided peripheral nerve blocks may be useful for major lower extremity surgery in patients with severe hemodynamic impairment. Conclusion: Perioperative management of embolism stroke patients undergoing above-knee amputation requires special attention in selecting anesthetics. Ultrasound-guided peripheral nerve blocks minimize patient hemodynamic changes and provide better postoperative pain control.

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“…Although it is safer to perform a lumbar plexus block than an epidural or spinal block for patients that are taking anticoagulants, there is still a significant risk of bleeding that can go unnoticed given that this block is deep. The German and Austrian Societies of Anesthesiology recommend the same guidelines be used for deep plexus blocks and neuraxial blocks when patients are on anticoagulants [16].…”

Section: Discussionmentioning

confidence: 99%

Complex Inpatient Pain Management in a Critically Ill Lung Transplant Recipient: A Case Report

Vajdi¹,

Lee²,

Vijjeswarapu³

2019

CRCM

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Thoracic surgery is known to cause severe pain that may not subside during the course of hospitalization. Early pain control is important in these patients because it improves ventilation and promotes mobility. Lung transplant recipients can experience post-operative complications that lead to extended hospital stays. This increases the time a patient is sedentary, which further deconditions patients; therefore, rehabilitation should be initiated early post-operatively. We present a unique case of a critically ill double lung transplant recipient whose rehabilitation post-operatively was hindered by severe vasopressor-induced ischemic pain. Due to debilitating pain, he was unable to regain mobility. His pain management course was challenging due to sensitivity to opioids, renal failure, and anticoagulation.

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Ultrasound-guided peripheral nerve blocks in anticoagulated patients – case series

Cited by 6 publications

References 23 publications

Axilary Block Ultrasound Guiding in Patient with Pseudoaneurysm Regio Brachii Sinistra pro Repair Pseudoaneurysm

Axilary Block Ultrasound Guiding in Patient with Pseudoaneurysm Regio Brachii Sinistra pro Repair Pseudoaneurysm

Ultrasound-Guided Sciatic and Femoral Block in Patient with Recent Embolism Stroke Undergo Amputation Above the Knee

Complex Inpatient Pain Management in a Critically Ill Lung Transplant Recipient: A Case Report

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