Upper Limb Blocks: Advances in Anesthesiology Research

AbstractPurpose of ReviewTo summarize the recent literature regarding regional anesthesia of the upper extremity.Recent FindingsBrachial plexus anatomy is more variable than previously believed. Several novel techniques for upper extremity blockade have been recently described. The ability of local anesthetic adjuvants and liposomal bupivacaine to prolong block duration has been investigated with mixed results. Regional anesthesia has played an important role in the expansion of ambulatory upper extremity surgery, especially shoulder arthroscopy and arthroplasty. Knowledge about the management of local anesthetic systemic toxicity remains essential for the safe performance of upper extremity blocks.SummaryThe widespread adoption of ultrasound guidance for nerve blocks and the increasing emphasis on value in healthcare have fostered numerous innovations in regional anesthesia of the upper extremity in recent years. Further research is needed to determine the best technique for diaphragm-sparing shoulder analgesia and the most appropriate role for liposomal bupivacaine.
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research

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Comparing techniques of general anesthesia and regional anesthesia in arthroscopic shoulder surgery, some studies have shown differences in the intensity of immediate postoperative pain and neuroendocrine response, but the inflammatory response when using balanced general anesthesia (BGA) vs. an ultrasound-guided (USG) single-dose interscalene block (SDIB) has not been compared.
Source: Journal of Shoulder and Elbow Surgery - Category: Orthopaedics Authors: Source Type: research
Publication date: Available online 11 June 2019Source: Arthroscopy TechniquesAuthor(s): Pia Kareena Quiñones, Soichi Hattori, Shin Yamada, Yuki Kato, Hiroshi OhuchiAbstractMuscle injuries commonly occur in athletes, and in severe cases, they can result in hematoma formation, leading to pain and loss of function. A technique for minimally invasive ultrasound-guided evacuation of muscle hematoma is presented. A simple and quick outpatient procedure done under local anesthesia for faster muscle recovery provided immediate decompression of the muscle compartment, leading to early return to play.
Source: Arthroscopy Techniques - Category: Surgery Source Type: research
ConclusionsAlthough larger studies are required to determine the true incidence of vocal cord paresis following ultrasound guided IBPB, our results suggest that incidence of unwanted nerve blockade other than brachial plexus is much lower than previously described.
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research
Conclusion: SHB is as effective as ISB for post-operative pain relief and with fewer complications due to selective blockade of suprascapular and axillary nerves.
Source: Indian Journal of Anaesthesia - Category: Anesthesiology Authors: Source Type: research
Authors: Demir U, Ince I, Aksoy M, Dostbil A, Arı MA, Sulak MM, Kose M, Tanios M, Ozmen O Abstract BACKGROUND: Postoperative pain is an important problem for patients undergoing shoulder surgery. Our study investigated analgesic efficacy, duration of analgesia, postoperative analgesic use and patient satisfaction with the use of preemptive intravenous dexketoprofen for interscalene block in addition to general anesthesia in arthroscopic shoulder surgery. METHODS: 60 patients, scheduled for arthroscopic shoulder surgery were randomized (30 patients each) into either: - control group (Group1) or dexketoprofen gr...
Source: Journal of Investigative Surgery - Category: Surgery Tags: J Invest Surg Source Type: research
Conclusion: FICB with a combination of ropivacaine and dexmedetomidine resulted in significant reduction of VAS scores with lower postoperative analgesic requirement after arthroscopic knee surgery. No adverse reactions or complications were noted except for lower heart rate in Group B patients.
Source: Saudi Journal of Anaesthesia - Category: Anesthesiology Authors: Source Type: research
Authors: Poboży T, Kielar M, Miąskiewicz J Abstract The aim of this manuscript is to present a modification of the current arthroscopic implantation technique of a biodegradable subacromial spacer. This modified ultrasound-guided technique was intended to maximally reduce the invasiveness of the procedure. The ultrasound technique was used to measure the subacromial space for an optimal fit and to verify subacromial spacer placement in the sagittal and frontal planes. This finding is of particular importance for patients with contraindications to general or regional anesthesia. The follow-up (5 months) of subacro...
Source: Videosurgery and Other Miniinvasive Techniques - Category: Surgery Tags: Wideochir Inne Tech Maloinwazyjne Source Type: research
ConclusionAddition of clonidine to ropivacaine in USG guided adductor canal block led to significant prolongation of pain free period though pain score at rest and movement and rescue analgesic requirement did not differ.ResumoJustificativa e objetivosO alívio inadequado da dor após a reconstrução do ligamento cruzado anterior afeta a mobilidade, levando ao desenvolvimento de aderências, fraca Inserção do ligamento e atrofia muscular. O bloqueio do canal adutor para analgesia pós-operatória preserva a força do quadríceps. O presente estudo foi real...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
Publication date: Available online 15 December 2018Source: Egyptian Journal of AnaesthesiaAuthor(s): Mohamed M. Abu Elyazed, Shaimaa F. MostafaAbstractBackground and objectivesIdeal analgesia following knee surgery is needed to encourage early rehabilitation, and to improve functional recovery. We studied the impacts of adductor canal block (ACB) versus fascia iliaca compartment block (FICB) using ultrasound guidance on postoperative analgesia, strength of quadriceps muscle and capability to mobilize following knee arthroscopy.Methods100 patients scheduled for elective arthroscopic knee surgery were randomly allotted to re...
Source: Egyptian Journal of Anaesthesia - Category: Anesthesiology Source Type: research
Conclusions Suprascapular-axillary nerve block is inferior to ISB in terms of analgesia and opioid requirement in the immediate period after arthroscopic shoulder surgery but is associated with a lower incidence of dyspnea and discomfort. The difference in pain and opioid consumption gradually decreases as the blocks wear off in order to reach similar pain scores during the first postoperative night and at 24 hours. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02415088.
Source: Regional Anesthesia and Pain Medicine - Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Original Articles Source Type: research
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