Ultrasound-guided superior and middle trunk brachial plexus block with superficial cervical plexus block for shoulder surgeries in high-risk patients: Case series

Vijayakumar, Vinodhadevi; Ganesamoorthi, Arimanickam; Subramaniyan, Nandhakumar; Kasirajan, Parthiban

doi:10.4103/jmu.jmu_73_19

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…Inclusion criteria: (1) all were diagnosed with mid-clavicle fracture by X-ray and high-frequency ultrasonography; (2) those who were to be treated with internal fixation of clavicle fracture; (3) clear consciousness, normal intelligence, and normal verbal communication; (4) ASA classification [9] were grade I-II; (5) unilateral fracture; (6) patients and family members voluntarily participated in this study and signed the informed consent form.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…According to statistics, patients with clavicle fractures account for about 10% of the total number of patients with fractures throughout the body, of which 70%-80% occur in the middle part of the clavicle [1][2] . Because the clavicle connects important organs such as the brachial plexus, subpulmonary, subclavian vessels, and the heart, fractures may damage the connected organs, including subclavian vessel injury, hemothorax, pneumothorax, and brachial plexus nerve injury [3][4] . The traditional conservative treatment is a wide-arm sling, but the recovery period is long.…”

Section: Introductionmentioning

confidence: 99%

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Effect of ultrasound-guided brachial plexus and superficial cervical plexus nerve block anesthesia in patients with middle clavicle fractures

2023

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To investigate the value of ultrasound-guided brachial plexus combined with superficial cervical plexus nerve block anesthesia in the surgery of patients with mid-clavicular fracture. Eighty patients with mid-clavicular fractures admitted to a hospital from January 2020 to December 2022 were selected for the study, and they were randomly divided into a control group and a study group, 40 patients in each group, and both groups were treated with internal fixation of clavicular fractures. The anesthetic effect and anesthesia, heart rate and blood pressure at different time points, serum adrenocorticotropic hormone (ACTH) and cortisol (Cor) levels before surgery and at the time of fracture reduction, and postoperative complications were compared between the two groups. The anesthetic effect of the study group was significantly better than that of the control group (P<0.05); the onset of anesthesia and sensory block were longer (P<0.05) and the recovery time of sensation was shorter (P<0.05) in the control group than in the study group; there was no significant difference between the heart rate and blood pressure of the two groups before anesthesia (P>0.05), and the heart rate and blood pressure of the control group at the time of stripping the periosteum, at the end of surgery and at 10 min after surgery were significantly different. The heart rate and blood pressure of the control group were higher than those of the study group at the time of stripping the periosteum, at the end of surgery and 10 min after surgery (P<0.05); before surgery, there was no significant difference in ACTH and Cor levels between the two groups (P>0.05), and after fracture reduction, ACTH and Cor levels increased in both groups, and the control group was higher than the study group (P<0.05); the incidence of postoperative complications was significantly higher in the control group than in the study group. The incidence of postoperative complications in the control group was significantly higher than that in the study group. Ultrasound-guided brachial plexus nerve combined with superficial cervical plexus nerve block anesthesia is effective in patients with mid-clavicular fracture, which can significantly improve the anesthetic effect, shorten the anesthesia time and sensory block onset time, prolong the sensory recovery time, maintain the stability of vital signs and hemodynamics, and reduce the incidence of postoperative complications, and has high application value and promotion significance.

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Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of ultrasound-guided brachial plexus and superficial cervical plexus nerve block anesthesia in patients with middle clavicle fractures

2023

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“…The innervation mainly originates from the cervical plexus and the brachial plexus (5,6). However, the hybrid technique of the superficial cervical plexus block and the interscalene block, which is an effective mode of RA in clavicle and shoulder surgery (7)(8)(9), cannot always provide sufficient surgical anesthesia for the patients undergoing PHF surgery. In previous studies, the branches stem from the upper thoracic nerves (T1-T2, even T3), nearly impossible to be covered by a brachial plexus block, were considered to contribute to the innervation of the upper arm as well (10,11).…”

Section: Introductionmentioning

confidence: 99%

Is It Useful and Necessary to Add a T2 Paravertebral Block to the Regional Anesthesia During Proximal Humeral Fracture Surgery in Elderly Patients? A Prospective and Randomized Controlled Trial

et al. 2022

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ObjectiveThis study was designed to investigate whether it is useful and necessary to add a T2 level thoracic paravertebral block (TPVB) based on brachial-cervical plexus block to avoid incomplete anesthesia in elderly patients undergoing deltopectoral approach proximal humeral fracture (PHF) surgery.Materials and MethodsThis study involved 80 patients scheduled for PHF surgery who were randomized to receive either IC block (combined interscalene brachial plexus with superficial cervical plexus block) or ICTP block (T2 TPVB supplemented with IC block). The primary outcome was the success rate of regional anesthesia. The patient who experienced incomplete block was administered with intravenous remifentanil for rescue, or conversion to general anesthesia (GA) if remifentanil was still ineffective. Secondary outcomes included requirements of rescue anesthesia, sensory block of the surgical region, the incidence of adverse reactions, and block procedure-related complications.ResultsThe success rate of regional anesthesia in the ICTP group was higher compared with the IC group (77.5 vs. 52.5%, p = 0.019). Intravenous remifentanil was required in 32.5% of patients in the IC group and 17.5% in the ICTP group, respectively. Conversion to GA was performed in 15% of patients in the IC group and 5% in the ICTP group. Sensory block at the medial proximal upper arm was achieved in 85% of patients in the ICTP group, whereas 10% in the IC group (p < 0.001). There was no difference between the groups with respect to the incidence of intraoperative adverse reactions. No block-related complications occurred in either group.ConclusionAdding a T2 TPVB is helpful to decrease, but not absolutely avoid the occurrence of incomplete regional anesthesia during PHF surgery in elderly patients. However, considering the potential risks, it is not an ideal option while a minor dose of remifentanil can provide a satisfactory rescue effect.Clinical Trial RegistrationClinicalTrials.gov, identifier: NCT03919422.

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Regional anesthesia for geriatric population

Al Harbi,

Alshaghroud,

Aljahdali

et al. 2023

Saudi J Anaesth

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Advancements in modern health care over 20 years have substantially increased the average lifespan in developed countries, and the fastest growing population is the elderly population. The proportion of people in Saudi Arabia aged 60 or more is predicted to be 25 percent of the total population of 40 million by the end of 2050. Moreover, the number of people aged 80 or more is expected to reach 1.6 million or 4 percent of the total population in the same period. Improvements in surgical techniques, anesthesia, and intensive care units make surgical interventions in older and sicker patients possible. It is estimated that over half of the population older than 65 years will require surgical intervention at least once during the remainder of their lives. Therefore, elderly patients are becoming an even larger part of anesthetic practice. Regional anesthesia (RA) is frequently used in elderly patients, especially during orthopedic surgery, genitourologic and gynecologic procedures, and hernia repair. Although age can no longer be considered a contraindication to anesthesia and surgery, anesthesia-related morbidity and mortality remain higher among elderly than among young adult surgical patients. Undoubtedly, peripheral nerve (PN) blocks improve analgesia and reduce opioid consumption and their associated side effects. This is beneficial in the perioperative care of elderly patients who may have less physiologic reserve to withstand the side effects of general anesthesia (GA).

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Ultrasound-guided superior and middle trunk brachial plexus block with superficial cervical plexus block for shoulder surgeries in high-risk patients: Case series

Cited by 3 publications

References 13 publications

Effect of ultrasound-guided brachial plexus and superficial cervical plexus nerve block anesthesia in patients with middle clavicle fractures

Effect of ultrasound-guided brachial plexus and superficial cervical plexus nerve block anesthesia in patients with middle clavicle fractures

Is It Useful and Necessary to Add a T2 Paravertebral Block to the Regional Anesthesia During Proximal Humeral Fracture Surgery in Elderly Patients? A Prospective and Randomized Controlled Trial

Regional anesthesia for geriatric population

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