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Gabriella Iohom - One of the best experts on this subject based on the ideXlab platform.

  • Continuing education Ultrasound guided axillary Brachial Plexus Block
    2020
    Co-Authors: Anil Ranganath, Karthikeyan Kallidaikurichi Srinivasan, Gabriella Iohom, Md Gabriella Iohom
    Abstract:

    Abstract The axillary Brachial Plexus Block is the most widely performed upper limb Block. It is relatively simple to perform and one of the safest approaches to Brachial Plexus Block. With the advent of ultrasound technology, there is a marked improvement in the success rate of the axillary Block. This review will focus on the technique of ultrasound guided axillary Brachial Plexus Block

  • fascial layers influence the spread of injectate during ultrasound guided infraclavicular Brachial Plexus Block a cadaver study
    BJA: British Journal of Anaesthesia, 2018
    Co-Authors: David Brenner, Gabriella Iohom, Padraig Mahon, Michael Cronin, Carrie Oflynn, G D Shorten
    Abstract:

    Background Fascial layers of the neurovascular sheath containing the Brachial Plexus influence distribution of local anaesthetic, hence increasing the risk of Block failure when performing infraclavicular Brachial Plexus Block (ICB). Methods Ultrasound-guided infraclavicular Brachial Plexus Block was performed on cadavers using a single injection technique with dye (20–30 ml). After injection, we carried out consecutive dissection of the neurovascular bundle to study dye injectate spread and identify the presence of fascial layers. Ultrasound video images (scout scan and injection) and recordings of dissections were evaluated by independent experts (regional anaesthetists and anatomists). Results Well defined fascial layers were identified at dissection in seven out of 12 infraclavicular spaces studied. These fascial layers impeded the spread of dye injectate substantially in six cases and partially in one case. No fascial layers were identified at dissection in five cases, in each of which the spread of injectate was complete throughout the neurovascular bundle. The sensitivity and specificity of ultrasonography and haptic sensation for detection of fascial layers were poor. Conclusions When fascial layers are present in the neurovascular sheath, they impede the spread of injectate during infraclavicular Brachial Plexus Block. Ultrasound detection of these fascial layers is unreliable in cadavers. These findings support the use of greater volumes of injectate or a multiple injection technique when performing this Block.

  • an estimation of the minimum effective anesthetic volume of 2 lidocaine in ultrasound guided axillary Brachial Plexus Block
    Anesthesiology, 2009
    Co-Authors: Brian D Odonnell, Gabriella Iohom
    Abstract:

    BACKGROUND: Ultrasound guidance facilitates precise needle and injectate placement, increasing axillary Block success rates, reducing onset times, and permitting local anesthetic dose reduction. The minimum effective volume of local anesthetic in ultrasound-guided axillary Brachial Plexus Block is unknown. The authors performed a study to estimate the minimum effective anesthetic volume of 2% lidocaine with 1:200,000 epinephrine (2% LidoEpi) in ultrasound-guided axillary Brachial Plexus Block. METHODS: After ethical approval and informed consent, patients undergoing hand surgery of less than 90 min duration were recruited. A step-up/step-down study model was used with nonprobability sequential dosing based on the outcome of the previous patient. The starting dose of 2% LidoEpi was 4 ml per nerve. Block failure resulted in a dose increase of 0.5 ml; Block success in a reduction of 0.5 ml.A blinded assistant assessed sensory and motor Blockade at 5-min intervals up to 30 min. Block performance time and duration were measured. Two predetermined stopping points were used; a minimum of five consecutive Block success/failures and five consecutive successful Blocks at 1 ml per nerve. RESULTS: The study was terminated when five consecutive patients had successful Blocks using 1 ml of 2% LidoEpi per nerve (overall group n = 11). All five patients had surgical anesthesia within 10 min. The mean (SD) Block performance time was 445 (100) s, and Block duration was 190 min (range 120-310 min). All surgical procedures were performed under regional anesthesia with anxiolytic sedation provided in 3 of 11 cases. CONCLUSION: Successful ultrasound-guided axillary Brachial Plexus Block may be performed with 1 ml per nerve of 2% LidoEpi.

Geert-jan Geffen - One of the best experts on this subject based on the ideXlab platform.

  • hemidiaphragmatic paresis can be avoided in ultrasound guided supraclavicular Brachial Plexus Block
    Regional Anesthesia and Pain Medicine, 2009
    Co-Authors: Steven H. Renes, Harald C Rettig, Hubertus H Spoormans, Mathieu J.m. Gielen, Geert-jan Geffen
    Abstract:

    Background and Objectives: Supraclavicular Brachial Plexus Block is associated with 50% to 67% incidence of hemidiaphragmatic paresis as a result of phrenic nerve Block. We examined whether ultrasound-guided compared with nerve stimulation supraclavicular Brachial Plexus Block using 0.75% ropivacaine results in a lower incidence of hemidiaphragmatic paresis. Methods: In a prospective randomized observer-blinded controlled trial, 60 patients scheduled for elective elbow, forearm, wrist, or hand surgery under supraclavicular Brachial Plexus Block without sedation were included. Supraclavicular Brachial Plexus Block was performed with 20 mL of 0.75% ropivacaine using either ultrasound or nerve stimulation guidance. Ventilatory function was assessed by ultrasound examination of hemidiaphragmatic movement and spirometry. Results: None of the 30 patients in the ultrasound group showed complete or partial paresis of the hemidiaphragm (95% confidence interval, 0.00-0.14), whereas in the nerve stimulation group, 15 patients showed complete paresis of the hemidiaphragm and 1 patient showed partial paresis of the hemidiaphragm (0% versus 53%, respectively; P Conclusions: Ultrasound-guided supraclavicular Brachial Plexus Block, using 20 mL of 0.75% ropivacaine with the described technique, is not associated with hemidiaphragmatic paresis.

  • ultrasound guided low dose interscalene Brachial Plexus Block reduces the incidence of hemidiaphragmatic paresis
    Regional Anesthesia and Pain Medicine, 2009
    Co-Authors: Steven H. Renes, Harald C Rettig, Oliver H G Wildersmith, Mathieu J.m. Gielen, Geert-jan Geffen
    Abstract:

    Background and Objectives: Interscalene Brachial Plexus Block is associated with 100% incidence of hemidiaphragmatic paresis as a result of phrenic nerve Block. We examined whether an ultrasound (US)-guided interscalene Brachial Plexus Block performed at the level of root C7 versus a nerve stimulation interscalene Brachial Plexus Block, both using 10 mL of ropivacaine 0.75%, resulted in a lower incidence of hemidiaphragmatic paresis. Methods: In a prospective randomized controlled trial, 30 patients scheduled for elective shoulder surgery under combined general anesthesia and interscalene Brachial Plexus Block were included. Interscalene Brachial Plexus Block using the same dose was performed using either US or nerve stimulation guidance of ropivacaine for both groups. General anesthesia was standardized. Ventilatory function was assessed using spirometry, and movement of the hemidiaphragm was assessed by US. Results: Two patients in the US group showed complete paresis of the hemidiaphragm, but in the nerve stimulation group, 12 patients showed complete and 2 patients had partial paresis of the hemidiaphragm (13% versus 93%, respectively; P Conclusions: Ultrasound-guided interscalene Brachial Plexus Block performed at the level of root C7 using 10 mL of ropivacaine 0.75% reduces the incidence of hemidiaphragmatic paresis.

Manoj K Karmakar - One of the best experts on this subject based on the ideXlab platform.

  • aberrant vascular anatomy at the costoclavicular space a word of caution for costoclavicular Brachial Plexus Block
    Regional Anesthesia and Pain Medicine, 2021
    Co-Authors: Ranjith Kumar Sivakumar, Pornpatra Areeruk, Manoj K Karmakar
    Abstract:

    To the Editor Since the introduction of the costoclavicular Brachial Plexus Block (CCBPB) in 2015[1][1] we have been using it as our technique of choice for infraclavicular Brachial Plexus Block (BPB).[2][2] At the costoclavicular space (CCS) the cords of the Brachial Plexus are clustered together

  • low volume Brachial Plexus Block providing surgical anesthesia for distal arm surgery comparing supraclavicular infraclavicular and axillary approach a randomized observer blind trial
    BioMed Research International, 2016
    Co-Authors: Mojgan Vazin, Manoj K Karmakar, Kenneth Jensen, Danja L. Kristensen, Mathias Hjort, Katrine Tanggaard, Thomas F. Bendtsen, Jens Børglum
    Abstract:

    Background. Distal arm surgery is widely performed under regional anesthesia with Brachial Plexus Block. The preponderance of evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different ultrasound-guided Brachial Plexus Block techniques restricting the total volume to 20 mL. Methods. 120 patients were prospectively randomized to ultrasound-guided Brachial Plexus Block with 20 mL ropivacaine 0.75% at either the supraclavicular, infraclavicular, or axillary level. Multiinjection technique was performed with all three approaches. Primary outcome measure was performance time. Results. Performance time and procedural pain were similar between groups. Needle passes and injection numbers were significantly reduced in the infraclavicular group ( ). Nerve visibility was significantly reduced in the axillary group ( ). Success-rate was significantly increased in the supraclavicular versus the axillary group ( ). Total anesthesia-related time was significantly reduced in the supraclavicular compared to the infraclavicular group ( ). Block duration was significantly increased in the infraclavicular group ( ). No early adverse effects occurred. Conclusion. Supraclavicular and infraclavicular Blocks exhibited favorable characteristics compared to the axillary Block. Supraclavicular Brachial Plexus Block with the multiinjection intracluster technique exhibited significantly reduced total anesthesia-related time and higher success rate without any early adverse events.

  • Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach: A Randomized Observer Blind Trial
    Hindawi Limited, 2016
    Co-Authors: Mojgan Vazin, Manoj K Karmakar, Kenneth Jensen, Danja L. Kristensen, Mathias Hjort, Katrine Tanggaard, Thomas F. Bendtsen, Jens Børglum
    Abstract:

    Background. Distal arm surgery is widely performed under regional anesthesia with Brachial Plexus Block. The preponderance of evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different ultrasound-guided Brachial Plexus Block techniques restricting the total volume to 20 mL. Methods. 120 patients were prospectively randomized to ultrasound-guided Brachial Plexus Block with 20 mL ropivacaine 0.75% at either the supraclavicular, infraclavicular, or axillary level. Multiinjection technique was performed with all three approaches. Primary outcome measure was performance time. Results. Performance time and procedural pain were similar between groups. Needle passes and injection numbers were significantly reduced in the infraclavicular group (P

Steven H. Renes - One of the best experts on this subject based on the ideXlab platform.

  • hemidiaphragmatic paresis can be avoided in ultrasound guided supraclavicular Brachial Plexus Block
    Regional Anesthesia and Pain Medicine, 2009
    Co-Authors: Steven H. Renes, Harald C Rettig, Hubertus H Spoormans, Mathieu J.m. Gielen, Geert-jan Geffen
    Abstract:

    Background and Objectives: Supraclavicular Brachial Plexus Block is associated with 50% to 67% incidence of hemidiaphragmatic paresis as a result of phrenic nerve Block. We examined whether ultrasound-guided compared with nerve stimulation supraclavicular Brachial Plexus Block using 0.75% ropivacaine results in a lower incidence of hemidiaphragmatic paresis. Methods: In a prospective randomized observer-blinded controlled trial, 60 patients scheduled for elective elbow, forearm, wrist, or hand surgery under supraclavicular Brachial Plexus Block without sedation were included. Supraclavicular Brachial Plexus Block was performed with 20 mL of 0.75% ropivacaine using either ultrasound or nerve stimulation guidance. Ventilatory function was assessed by ultrasound examination of hemidiaphragmatic movement and spirometry. Results: None of the 30 patients in the ultrasound group showed complete or partial paresis of the hemidiaphragm (95% confidence interval, 0.00-0.14), whereas in the nerve stimulation group, 15 patients showed complete paresis of the hemidiaphragm and 1 patient showed partial paresis of the hemidiaphragm (0% versus 53%, respectively; P Conclusions: Ultrasound-guided supraclavicular Brachial Plexus Block, using 20 mL of 0.75% ropivacaine with the described technique, is not associated with hemidiaphragmatic paresis.

  • ultrasound guided low dose interscalene Brachial Plexus Block reduces the incidence of hemidiaphragmatic paresis
    Regional Anesthesia and Pain Medicine, 2009
    Co-Authors: Steven H. Renes, Harald C Rettig, Oliver H G Wildersmith, Mathieu J.m. Gielen, Geert-jan Geffen
    Abstract:

    Background and Objectives: Interscalene Brachial Plexus Block is associated with 100% incidence of hemidiaphragmatic paresis as a result of phrenic nerve Block. We examined whether an ultrasound (US)-guided interscalene Brachial Plexus Block performed at the level of root C7 versus a nerve stimulation interscalene Brachial Plexus Block, both using 10 mL of ropivacaine 0.75%, resulted in a lower incidence of hemidiaphragmatic paresis. Methods: In a prospective randomized controlled trial, 30 patients scheduled for elective shoulder surgery under combined general anesthesia and interscalene Brachial Plexus Block were included. Interscalene Brachial Plexus Block using the same dose was performed using either US or nerve stimulation guidance of ropivacaine for both groups. General anesthesia was standardized. Ventilatory function was assessed using spirometry, and movement of the hemidiaphragm was assessed by US. Results: Two patients in the US group showed complete paresis of the hemidiaphragm, but in the nerve stimulation group, 12 patients showed complete and 2 patients had partial paresis of the hemidiaphragm (13% versus 93%, respectively; P Conclusions: Ultrasound-guided interscalene Brachial Plexus Block performed at the level of root C7 using 10 mL of ropivacaine 0.75% reduces the incidence of hemidiaphragmatic paresis.

Mathieu J.m. Gielen - One of the best experts on this subject based on the ideXlab platform.

  • hemidiaphragmatic paresis can be avoided in ultrasound guided supraclavicular Brachial Plexus Block
    Regional Anesthesia and Pain Medicine, 2009
    Co-Authors: Steven H. Renes, Harald C Rettig, Hubertus H Spoormans, Mathieu J.m. Gielen, Geert-jan Geffen
    Abstract:

    Background and Objectives: Supraclavicular Brachial Plexus Block is associated with 50% to 67% incidence of hemidiaphragmatic paresis as a result of phrenic nerve Block. We examined whether ultrasound-guided compared with nerve stimulation supraclavicular Brachial Plexus Block using 0.75% ropivacaine results in a lower incidence of hemidiaphragmatic paresis. Methods: In a prospective randomized observer-blinded controlled trial, 60 patients scheduled for elective elbow, forearm, wrist, or hand surgery under supraclavicular Brachial Plexus Block without sedation were included. Supraclavicular Brachial Plexus Block was performed with 20 mL of 0.75% ropivacaine using either ultrasound or nerve stimulation guidance. Ventilatory function was assessed by ultrasound examination of hemidiaphragmatic movement and spirometry. Results: None of the 30 patients in the ultrasound group showed complete or partial paresis of the hemidiaphragm (95% confidence interval, 0.00-0.14), whereas in the nerve stimulation group, 15 patients showed complete paresis of the hemidiaphragm and 1 patient showed partial paresis of the hemidiaphragm (0% versus 53%, respectively; P Conclusions: Ultrasound-guided supraclavicular Brachial Plexus Block, using 20 mL of 0.75% ropivacaine with the described technique, is not associated with hemidiaphragmatic paresis.

  • ultrasound guided low dose interscalene Brachial Plexus Block reduces the incidence of hemidiaphragmatic paresis
    Regional Anesthesia and Pain Medicine, 2009
    Co-Authors: Steven H. Renes, Harald C Rettig, Oliver H G Wildersmith, Mathieu J.m. Gielen, Geert-jan Geffen
    Abstract:

    Background and Objectives: Interscalene Brachial Plexus Block is associated with 100% incidence of hemidiaphragmatic paresis as a result of phrenic nerve Block. We examined whether an ultrasound (US)-guided interscalene Brachial Plexus Block performed at the level of root C7 versus a nerve stimulation interscalene Brachial Plexus Block, both using 10 mL of ropivacaine 0.75%, resulted in a lower incidence of hemidiaphragmatic paresis. Methods: In a prospective randomized controlled trial, 30 patients scheduled for elective shoulder surgery under combined general anesthesia and interscalene Brachial Plexus Block were included. Interscalene Brachial Plexus Block using the same dose was performed using either US or nerve stimulation guidance of ropivacaine for both groups. General anesthesia was standardized. Ventilatory function was assessed using spirometry, and movement of the hemidiaphragm was assessed by US. Results: Two patients in the US group showed complete paresis of the hemidiaphragm, but in the nerve stimulation group, 12 patients showed complete and 2 patients had partial paresis of the hemidiaphragm (13% versus 93%, respectively; P Conclusions: Ultrasound-guided interscalene Brachial Plexus Block performed at the level of root C7 using 10 mL of ropivacaine 0.75% reduces the incidence of hemidiaphragmatic paresis.

  • ultrasound guided interscalene Brachial Plexus Block in a child with femur fibula ulna syndrome
    Pediatric Anesthesia, 2006
    Co-Authors: Geert J Van Geffen, Luc K P Tielens, Mathieu J.m. Gielen
    Abstract:

    Ultrasound-guided interscalene Brachial Plexus Block is described in a 7-year-old child with femur fibula ulna syndrome. It is suggested that ultrasound is a useful tool in situations where nerve stimulation for nerve localization cannot be used.