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De Q H Tran - One of the best experts on this subject based on the ideXlab platform.

  • randomized comparison between perineural dexamethasone and dexmedetomidine for ultrasound guided Infraclavicular Block
    Regional Anesthesia and Pain Medicine, 2019
    Co-Authors: Julian Aliste, Roderick J Finlayson, Daniela Bravo, Sebastian Layera, Diego Fernandez, Alvaro Jara, Armando Garcia, De Q H Tran
    Abstract:

    Background This randomized trial compared perineural dexamethasone (5 mg) and dexmedetomidine (100 µg) for ultrasound-guided Infraclavicular brachial plexus Block. We hypothesized that both adjuvants would result in similar durations of motor Block and therefore designed the study as an equivalence trial (equivalence margin=3.0 hours). Methods One hundred and twenty patients undergoing upper limb surgery with ultrasound-guided Infraclavicular Block (using 35 mL of lidocaine 1%–bupivacaine 0.25% with epinephrine 5 µg/mL) were randomly allocated to receive perineural dexamethasone (5 mg) or dexmedetomidine (100 µg). Patients and operators were blinded to the nature of the perineural adjuvant. After the performance of the Block, a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min) as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental Blocks, intravenous opioids, or general anesthesia). Heart rate and blood pressure were recorded before the Block as well as during the first 2 hours after its performance. Furthermore, the level of sedation (using the Ramsay Sedation Scale) was recorded in the postanesthesia care unit. Postoperatively, the blinded observer contacted patients with successful Blocks to inquire about the duration of motor Block, sensory Block, and postoperative analgesia. Results No intergroup differences were observed in terms of success rate and surgical anesthesia. Compared with dexmedetomidine, dexamethasone provided longer durations of motor Block (17.4 (4.0) vs 14.3 (3.0) hours; p Conclusion Compared with dexmedetomidine (100 µg), dexamethasone (5 mg) results in longer sensorimotor Block and analgesic durations, as well as a decreased level of patient sedation. Further studies are required to compare dexamethasone and dexmedetomidine using different doses, local anesthetic agents, and approaches to the brachial plexus. Trial registration number NCT03610893

  • retroclavicular approach to Infraclavicular brachial plexus Block a logical conundrum
    Regional Anesthesia and Pain Medicine, 2019
    Co-Authors: Prangmalee Leurcharusmee, Roderick J Finlayson, Sebastian Layera, De Q H Tran
    Abstract:

    We read with great interest the cadaveric study by Drs Sancheti et al ,[1][1] which explored the structures encountered by the needle tip (under the clavicle) during the performance of the retroclavicular Infraclavicular Block. We would like to commend the authors for the elegance of their protocol

  • a randomized comparison between costoclavicular and paracoracoid ultrasound guided Infraclavicular Block for upper limb surgery
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2017
    Co-Authors: Prangmalee Leurcharusmee, Roderick J Finlayson, Julian Aliste, Worakamol Tiyaprasertkul, Artid Samerchua, Maria Francisca Elgueta, Thitipan Sotthisopha, Aida Gordon, De Q H Tran
    Abstract:

    This two-centre randomized trial compared costoclavicular and paracoracoid ultrasound-guided Infraclavicular brachial plexus Block in patients undergoing upper limb surgery. We hypothesized that both techniques would result in similar onset times and designed the study as an equivalence trial. Ninety patients undergoing upper limb surgery at or distal to the elbow were randomly allocated to receive a costoclavicular (n = 45) or paracoracoid (n = 45) ultrasound-guided Infraclavicular brachial plexus Block. Both groups received a 35-mL mixture of 1% lidocaine–0.25% bupivacaine with epinephrine 5 µg·mL−1. In the costoclavicular group, local anesthetic was injected into the costoclavicular space in the middle of the three cords of the brachial plexus. In the paracoracoid group, local anesthetic was deposited dorsal to the axillary artery in the lateral Infraclavicular fossa. A blinded observer recorded the Block onset time (primary endpoint), success rate (i.e., surgical anesthesia), Block-related pain scores, as well as the incidence of hemidiaphragmatic paralysis. Performance time and the number of needle passes were also recorded during the performance of the Block. The total anesthesia-related time was defined as the sum of the performance and onset times. The mean (SD) onset times were comparable between the costoclavicular and paracoracoid groups [16.0 (7.5) min vs 16.8 (6.2) min, respectively; mean difference, 0.8; 95% confidence interval, -2.3 to 3.8; P = 0.61]. Furthermore, no intergroup differences were found in terms of performance time (P = 0.09), total anesthesia-related time (P = 0.90), surgical anesthesia (P > 0.99), and hemidiaphragmatic paralysis (P > 0.99). The paracoracoid technique required marginally fewer median [interquartile range] needle passes than the costoclavicular technique (2 [1-4] vs 2 [1-6], respectively; P = 0.048); however, procedural pain was comparable between the two study groups. Costoclavicular and paracoracoid ultrasound-guided Infraclavicular Blocks resulted in similar onset times. Furthermore, no intergroup differences were found in terms of performance times and success rates. Future dose-finding trials are required to elucidate the minimum effective volume of local anesthetic for costoclavicular Infraclavicular Blocks. This trial was registered at www.clinicaltrials.in.th (Study ID: TCTR20160525001).

  • a multicenter randomized comparison between intravenous and perineural dexamethasone for ultrasound guided Infraclavicular Block
    Regional Anesthesia and Pain Medicine, 2016
    Co-Authors: Prangmalee Leurcharusmee, Roderick J Finlayson, Julian Aliste, Tom C R V Van Zundert, Phatthanaphol Engsusophon, Vanlapa Arnuntasupakul, Worakamol Tiyaprasertkul, Amornrat Tangjitbampenbun, Sonia Ahkye, De Q H Tran
    Abstract:

    Background and Objectives This multicenter, randomized trial compared intravenous (IV) and perineural (PN) dexamethasone for ultrasound (US)-guided Infraclavicular brachial plexus Block. Our research hypothesis was both modalities would result in similar durations of motor Block. Methods One hundred fifty patients undergoing upper limb surgery with US-guided Infraclavicular Block were randomly allocated to receive IV or PN dexamethasone (5 mg). The local anesthetic agent (35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 μg/mL) was identical in all subjects. Patients and operators were blinded to the nature of IV and PN injectates. During the performance of the Block, the performance time, number of needle passes, procedural pain, and complications (vascular puncture, paresthesia) were recorded. Subsequently, a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 of 16 points at 30 minutes), onset time as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental Blocks, IV opioids, or general anesthesia). Postoperatively (at 24 hours), the blinded observer contacted patients with successful Blocks to enquire about the duration of motor Block, sensory Block, and postoperative analgesia. The main outcome variable was the duration of motor Block. Results No intergroup differences were observed in terms of technical execution (performance time/number of needle passes/procedural pain/complications), onset time, success rate, and surgical anesthesia. However, compared to its IV counterpart, PN dexamethasone provided 19% to 22% longer durations for motor Block (15.7 ± 6.2 vs 12.9 ± 5.5 hours; P = 0.009), sensory Block (16.8 ± 4.4 vs 13.9 ± 5.4 hours; P = 0.002), and postoperative analgesia (22.1 ± 8.5 vs 18.6 ± 6.7 hours; P = 0.014). Conclusions Compared with its IV counterpart, PN dexamethasone (5 mg) provides a longer duration of motor Block, sensory Block, and postoperative analgesia for US-guided Infraclavicular Block. Future dose-finding studies are required to elucidate the optimal dose of dexamethasone.

  • a randomized comparison between Infraclavicular Block and targeted intracluster injection supraclavicular Block
    Regional Anesthesia and Pain Medicine, 2015
    Co-Authors: Murray S Yazer, Roderick J Finlayson, De Q H Tran
    Abstract:

    Background and Objectives This prospective, randomized trial compared ultrasound-guided targeted intracluster injection (TII) supraclavicular brachial plexus Block (SCB) and Infraclavicular brachial plexus Block (ICB). Methods Sixty-four patients were randomly allocated to receive an ultrasound-guided TII SCB (n = 32) or ICB (n = 32). The local anesthetic agent (lidocaine 1.5% with epinephrine 5 μg/mL) was identical in all subjects. In the TII SCB group, half the volume (16 mL) was injected inside the largest neural cluster (confluence of trunks and divisions of the brachial plexus). Subsequently, the remaining half (16 mL) was divided into equal aliquots and injected inside every single satellite cluster. In the ICB group, the entire volume (35 mL) was injected dorsal to the axillary artery. During the performance of the Block, the performance time, number of needle passes, procedural pain, and complications (vascular puncture, paresthesia) were recorded. Subsequently, a blinded observer assessed the onset time, incidence of Horner syndrome, and success rate (surgical anesthesia). The main outcome variable was the total anesthesia-related time (sum of performance and onset times). Results Due to a quicker onset [8.9 (5.6) vs 17.6 (5.3) minutes; P Conclusions Ultrasound-guided TII SCB and ICB provide comparable success rates. Due to its quick onset, TII SCB results in a shorter total anesthesia-related time.

Roderick J Finlayson - One of the best experts on this subject based on the ideXlab platform.

  • randomized comparison between perineural dexamethasone and dexmedetomidine for ultrasound guided Infraclavicular Block
    Regional Anesthesia and Pain Medicine, 2019
    Co-Authors: Julian Aliste, Roderick J Finlayson, Daniela Bravo, Sebastian Layera, Diego Fernandez, Alvaro Jara, Armando Garcia, De Q H Tran
    Abstract:

    Background This randomized trial compared perineural dexamethasone (5 mg) and dexmedetomidine (100 µg) for ultrasound-guided Infraclavicular brachial plexus Block. We hypothesized that both adjuvants would result in similar durations of motor Block and therefore designed the study as an equivalence trial (equivalence margin=3.0 hours). Methods One hundred and twenty patients undergoing upper limb surgery with ultrasound-guided Infraclavicular Block (using 35 mL of lidocaine 1%–bupivacaine 0.25% with epinephrine 5 µg/mL) were randomly allocated to receive perineural dexamethasone (5 mg) or dexmedetomidine (100 µg). Patients and operators were blinded to the nature of the perineural adjuvant. After the performance of the Block, a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min) as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental Blocks, intravenous opioids, or general anesthesia). Heart rate and blood pressure were recorded before the Block as well as during the first 2 hours after its performance. Furthermore, the level of sedation (using the Ramsay Sedation Scale) was recorded in the postanesthesia care unit. Postoperatively, the blinded observer contacted patients with successful Blocks to inquire about the duration of motor Block, sensory Block, and postoperative analgesia. Results No intergroup differences were observed in terms of success rate and surgical anesthesia. Compared with dexmedetomidine, dexamethasone provided longer durations of motor Block (17.4 (4.0) vs 14.3 (3.0) hours; p Conclusion Compared with dexmedetomidine (100 µg), dexamethasone (5 mg) results in longer sensorimotor Block and analgesic durations, as well as a decreased level of patient sedation. Further studies are required to compare dexamethasone and dexmedetomidine using different doses, local anesthetic agents, and approaches to the brachial plexus. Trial registration number NCT03610893

  • retroclavicular approach to Infraclavicular brachial plexus Block a logical conundrum
    Regional Anesthesia and Pain Medicine, 2019
    Co-Authors: Prangmalee Leurcharusmee, Roderick J Finlayson, Sebastian Layera, De Q H Tran
    Abstract:

    We read with great interest the cadaveric study by Drs Sancheti et al ,[1][1] which explored the structures encountered by the needle tip (under the clavicle) during the performance of the retroclavicular Infraclavicular Block. We would like to commend the authors for the elegance of their protocol

  • a randomized comparison between costoclavicular and paracoracoid ultrasound guided Infraclavicular Block for upper limb surgery
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2017
    Co-Authors: Prangmalee Leurcharusmee, Roderick J Finlayson, Julian Aliste, Worakamol Tiyaprasertkul, Artid Samerchua, Maria Francisca Elgueta, Thitipan Sotthisopha, Aida Gordon, De Q H Tran
    Abstract:

    This two-centre randomized trial compared costoclavicular and paracoracoid ultrasound-guided Infraclavicular brachial plexus Block in patients undergoing upper limb surgery. We hypothesized that both techniques would result in similar onset times and designed the study as an equivalence trial. Ninety patients undergoing upper limb surgery at or distal to the elbow were randomly allocated to receive a costoclavicular (n = 45) or paracoracoid (n = 45) ultrasound-guided Infraclavicular brachial plexus Block. Both groups received a 35-mL mixture of 1% lidocaine–0.25% bupivacaine with epinephrine 5 µg·mL−1. In the costoclavicular group, local anesthetic was injected into the costoclavicular space in the middle of the three cords of the brachial plexus. In the paracoracoid group, local anesthetic was deposited dorsal to the axillary artery in the lateral Infraclavicular fossa. A blinded observer recorded the Block onset time (primary endpoint), success rate (i.e., surgical anesthesia), Block-related pain scores, as well as the incidence of hemidiaphragmatic paralysis. Performance time and the number of needle passes were also recorded during the performance of the Block. The total anesthesia-related time was defined as the sum of the performance and onset times. The mean (SD) onset times were comparable between the costoclavicular and paracoracoid groups [16.0 (7.5) min vs 16.8 (6.2) min, respectively; mean difference, 0.8; 95% confidence interval, -2.3 to 3.8; P = 0.61]. Furthermore, no intergroup differences were found in terms of performance time (P = 0.09), total anesthesia-related time (P = 0.90), surgical anesthesia (P > 0.99), and hemidiaphragmatic paralysis (P > 0.99). The paracoracoid technique required marginally fewer median [interquartile range] needle passes than the costoclavicular technique (2 [1-4] vs 2 [1-6], respectively; P = 0.048); however, procedural pain was comparable between the two study groups. Costoclavicular and paracoracoid ultrasound-guided Infraclavicular Blocks resulted in similar onset times. Furthermore, no intergroup differences were found in terms of performance times and success rates. Future dose-finding trials are required to elucidate the minimum effective volume of local anesthetic for costoclavicular Infraclavicular Blocks. This trial was registered at www.clinicaltrials.in.th (Study ID: TCTR20160525001).

  • a multicenter randomized comparison between intravenous and perineural dexamethasone for ultrasound guided Infraclavicular Block
    Regional Anesthesia and Pain Medicine, 2016
    Co-Authors: Prangmalee Leurcharusmee, Roderick J Finlayson, Julian Aliste, Tom C R V Van Zundert, Phatthanaphol Engsusophon, Vanlapa Arnuntasupakul, Worakamol Tiyaprasertkul, Amornrat Tangjitbampenbun, Sonia Ahkye, De Q H Tran
    Abstract:

    Background and Objectives This multicenter, randomized trial compared intravenous (IV) and perineural (PN) dexamethasone for ultrasound (US)-guided Infraclavicular brachial plexus Block. Our research hypothesis was both modalities would result in similar durations of motor Block. Methods One hundred fifty patients undergoing upper limb surgery with US-guided Infraclavicular Block were randomly allocated to receive IV or PN dexamethasone (5 mg). The local anesthetic agent (35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 μg/mL) was identical in all subjects. Patients and operators were blinded to the nature of IV and PN injectates. During the performance of the Block, the performance time, number of needle passes, procedural pain, and complications (vascular puncture, paresthesia) were recorded. Subsequently, a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 of 16 points at 30 minutes), onset time as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental Blocks, IV opioids, or general anesthesia). Postoperatively (at 24 hours), the blinded observer contacted patients with successful Blocks to enquire about the duration of motor Block, sensory Block, and postoperative analgesia. The main outcome variable was the duration of motor Block. Results No intergroup differences were observed in terms of technical execution (performance time/number of needle passes/procedural pain/complications), onset time, success rate, and surgical anesthesia. However, compared to its IV counterpart, PN dexamethasone provided 19% to 22% longer durations for motor Block (15.7 ± 6.2 vs 12.9 ± 5.5 hours; P = 0.009), sensory Block (16.8 ± 4.4 vs 13.9 ± 5.4 hours; P = 0.002), and postoperative analgesia (22.1 ± 8.5 vs 18.6 ± 6.7 hours; P = 0.014). Conclusions Compared with its IV counterpart, PN dexamethasone (5 mg) provides a longer duration of motor Block, sensory Block, and postoperative analgesia for US-guided Infraclavicular Block. Future dose-finding studies are required to elucidate the optimal dose of dexamethasone.

  • a randomized comparison between Infraclavicular Block and targeted intracluster injection supraclavicular Block
    Regional Anesthesia and Pain Medicine, 2015
    Co-Authors: Murray S Yazer, Roderick J Finlayson, De Q H Tran
    Abstract:

    Background and Objectives This prospective, randomized trial compared ultrasound-guided targeted intracluster injection (TII) supraclavicular brachial plexus Block (SCB) and Infraclavicular brachial plexus Block (ICB). Methods Sixty-four patients were randomly allocated to receive an ultrasound-guided TII SCB (n = 32) or ICB (n = 32). The local anesthetic agent (lidocaine 1.5% with epinephrine 5 μg/mL) was identical in all subjects. In the TII SCB group, half the volume (16 mL) was injected inside the largest neural cluster (confluence of trunks and divisions of the brachial plexus). Subsequently, the remaining half (16 mL) was divided into equal aliquots and injected inside every single satellite cluster. In the ICB group, the entire volume (35 mL) was injected dorsal to the axillary artery. During the performance of the Block, the performance time, number of needle passes, procedural pain, and complications (vascular puncture, paresthesia) were recorded. Subsequently, a blinded observer assessed the onset time, incidence of Horner syndrome, and success rate (surgical anesthesia). The main outcome variable was the total anesthesia-related time (sum of performance and onset times). Results Due to a quicker onset [8.9 (5.6) vs 17.6 (5.3) minutes; P Conclusions Ultrasound-guided TII SCB and ICB provide comparable success rates. Due to its quick onset, TII SCB results in a shorter total anesthesia-related time.

Kamil Toker - One of the best experts on this subject based on the ideXlab platform.

  • awake hand surgery under ultrasound guided Infraclavicular Block is possible for cooperative children
    The journal of the Turkish Society of Algology, 2016
    Co-Authors: Hulya Yilmaz Yanal, Yavuz Gurkan, Mine Solak, Alparslan Kus, Onur Balaban, Kamil Toker
    Abstract:

    In recent years, brachial plexus anesthesia techniques for upper limb surgery have been used more and more commonly on children; however, the patient is typically under deep sedation or general anesthesia. For eligible, cooperative children, surgery can also be performed using regional Blocks while the patient is awake. We present 5 cases in which Ultrasound (US)-guided Infraclavicular brachial plexus Blocks (ICB) were used on children for hand or forearm surgery. Surgical anesthesia was achieved in all patients and surgery was completed uneventfully using brachial plexus anesthesia, without need for deep sedation.

  • is nerve stimulation needed during an ultrasound guided lateral sagittal Infraclavicular Block
    Acta Anaesthesiologica Scandinavica, 2010
    Co-Authors: Yavuz Gurkan, Mine Solak, Sertan Acar, Murat Tekin, Kamil Toker
    Abstract:

    Background: The objective of the study was to evaluate the influence of ultrasound (US) guidance alone vs. neurostimulation (NS) and US (NSUS) guidance techniques on Block performance time and Block success rate for the lateral sagittal Infraclavicular Block (LSIB). Methods: In a randomized and prospective manner, 110 adult patients scheduled for distal upper limb surgery were allocated to the US or the NSUS groups. In the US group, a local anesthetic (LA) was administered only with US guidance to produce a ‘U’-shaped distribution around the axillary artery. In the NSUS group, LA was administered under US guidance only after electrolocation of one of the median, ulnar or radial nerve-type responses. A total of 30 ml of LA (10 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml) was administered in both groups. Sensory Block was tested at 10 min intervals for 30 min. Successful Block was defined as analgesia or anesthesia of all five nerves distal to the elbow. Results: Block success rate was 94.5% in both groups. Block performance time was significantly shorter in the US than the NSUS group (157 ± 50 vs. 230 ± 104 s) (P=0.000). Block onset time was similar in both groups (12.5 ± 4.8 in the US vs. 12.8 ± 5.4 min in the NSUS groups). There were two arterial punctures in the NSUS group. Conclusions: During LSIB performance US guidance alone produces Block success rate identical to both US and NS guidance yet with a shorter Block performance time.

  • comparison of nerve stimulation vs ultrasound guided lateral sagittal Infraclavicular Block
    Acta Anaesthesiologica Scandinavica, 2008
    Co-Authors: Yavuz Gurkan, Mine Solak, Sertan Acar, Kamil Toker
    Abstract:

    Background: A nerve stimulation-guided lateral sagittal Infraclavicular Block (LSIB) has been proven to be an effective Block. The purpose of this study was to evaluate whether the use of ultrasound (US) guidance would further improve the Block quality of LSIB. Methods: In a prospective manner, 80 adult patients scheduled for hand, wrist and forearm surgery were randomly allocated to US or nerve stimulation (NS) groups. A needle was inserted into a sagittal plane, 20° dorsally, until muscle twitches were observed in synchrony with the stimulation. In the US group, the Block was performed using the same puncture site but under ultrasonic guidance. The final position of the needle was verified with the use of a nerve stimulator. A local anesthetic mixture of 20 ml of levobupivacaine, 5 mg/ml and 20 ml of lidocaine and 20 mg/ml with 5 μg/ml epinephrine (total 40 ml) was administered in both groups. Results: The Block was successful in 37 patients in the NS group and 38 patients in the US group. Block efficacy was better in the US group than the group NS in radial nerve distribution at 20 min (P<0.05). In the US group, there was a slight tendency toward better Block density in other nerve areas also but these differences were not significant. Vascular puncture was noted in three patients in the NS group and none in the US group. Conclusions: The Block success rate was high and comparable in both groups. There was a trend toward improved Block quality in the US group, although not significant.

  • lateral sagittal Infraclavicular Block clinical experience in 380 patients
    Acta Anaesthesiologica Scandinavica, 2008
    Co-Authors: Yavuz Gurkan, Tulay Hosten, Mine Solak, Kamil Toker
    Abstract:

    Background The purpose of this study was to evaluate the clinical utility and Block success rate of 'lateral sagittal Infraclavicular Block (LSIB)' in a large-scale clinical study. Methods Adult patients scheduled for hand, wrist and forearm surgery between March 2005 and June 2007 were prospectively included into the study. Using a nerve stimulator LSIB was performed. In the LSIB technique the puncture site is immediately adjacent to the most medial point of the coracoid process and the anterior surface of the clavicula. The needle is inserted caudally in a sagittal plane, 20 degrees dorsally (downwards), until muscle twitches are observed in synchrony with the stimulation. A Local anesthetic mixture of either 20 ml bupivacaine 5 mg/ml or 20 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml with 5 microg/ml epinephrine (total volume 40 ml) was administered following electrolocation of the median, radial or ulnar nerve. Results Three-hundred and eighty patients were included into the study. Block was successful in 341 (89.7%) patients without any need for local anesthetic supplementation. We had complete failure in 17 (4.5%) patients and these patients received general anesthesia. Twenty-two (5.8%) patients needed either infiltration of local anesthetic at the site of skin incision or supplementation of the Block at the axilla. No other complications other than vascular punctures - 25 patients (6.6%) - were observed. Conclusions LSIB provided a clinically acceptable success rate and our results are in agreement with other studies assessing this approach.

Yavuz Gurkan - One of the best experts on this subject based on the ideXlab platform.

  • awake hand surgery under ultrasound guided Infraclavicular Block is possible for cooperative children
    The journal of the Turkish Society of Algology, 2016
    Co-Authors: Hulya Yilmaz Yanal, Yavuz Gurkan, Mine Solak, Alparslan Kus, Onur Balaban, Kamil Toker
    Abstract:

    In recent years, brachial plexus anesthesia techniques for upper limb surgery have been used more and more commonly on children; however, the patient is typically under deep sedation or general anesthesia. For eligible, cooperative children, surgery can also be performed using regional Blocks while the patient is awake. We present 5 cases in which Ultrasound (US)-guided Infraclavicular brachial plexus Blocks (ICB) were used on children for hand or forearm surgery. Surgical anesthesia was achieved in all patients and surgery was completed uneventfully using brachial plexus anesthesia, without need for deep sedation.

  • is nerve stimulation needed during an ultrasound guided lateral sagittal Infraclavicular Block
    Acta Anaesthesiologica Scandinavica, 2010
    Co-Authors: Yavuz Gurkan, Mine Solak, Sertan Acar, Murat Tekin, Kamil Toker
    Abstract:

    Background: The objective of the study was to evaluate the influence of ultrasound (US) guidance alone vs. neurostimulation (NS) and US (NSUS) guidance techniques on Block performance time and Block success rate for the lateral sagittal Infraclavicular Block (LSIB). Methods: In a randomized and prospective manner, 110 adult patients scheduled for distal upper limb surgery were allocated to the US or the NSUS groups. In the US group, a local anesthetic (LA) was administered only with US guidance to produce a ‘U’-shaped distribution around the axillary artery. In the NSUS group, LA was administered under US guidance only after electrolocation of one of the median, ulnar or radial nerve-type responses. A total of 30 ml of LA (10 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml) was administered in both groups. Sensory Block was tested at 10 min intervals for 30 min. Successful Block was defined as analgesia or anesthesia of all five nerves distal to the elbow. Results: Block success rate was 94.5% in both groups. Block performance time was significantly shorter in the US than the NSUS group (157 ± 50 vs. 230 ± 104 s) (P=0.000). Block onset time was similar in both groups (12.5 ± 4.8 in the US vs. 12.8 ± 5.4 min in the NSUS groups). There were two arterial punctures in the NSUS group. Conclusions: During LSIB performance US guidance alone produces Block success rate identical to both US and NS guidance yet with a shorter Block performance time.

  • comparison of nerve stimulation vs ultrasound guided lateral sagittal Infraclavicular Block
    Acta Anaesthesiologica Scandinavica, 2008
    Co-Authors: Yavuz Gurkan, Mine Solak, Sertan Acar, Kamil Toker
    Abstract:

    Background: A nerve stimulation-guided lateral sagittal Infraclavicular Block (LSIB) has been proven to be an effective Block. The purpose of this study was to evaluate whether the use of ultrasound (US) guidance would further improve the Block quality of LSIB. Methods: In a prospective manner, 80 adult patients scheduled for hand, wrist and forearm surgery were randomly allocated to US or nerve stimulation (NS) groups. A needle was inserted into a sagittal plane, 20° dorsally, until muscle twitches were observed in synchrony with the stimulation. In the US group, the Block was performed using the same puncture site but under ultrasonic guidance. The final position of the needle was verified with the use of a nerve stimulator. A local anesthetic mixture of 20 ml of levobupivacaine, 5 mg/ml and 20 ml of lidocaine and 20 mg/ml with 5 μg/ml epinephrine (total 40 ml) was administered in both groups. Results: The Block was successful in 37 patients in the NS group and 38 patients in the US group. Block efficacy was better in the US group than the group NS in radial nerve distribution at 20 min (P<0.05). In the US group, there was a slight tendency toward better Block density in other nerve areas also but these differences were not significant. Vascular puncture was noted in three patients in the NS group and none in the US group. Conclusions: The Block success rate was high and comparable in both groups. There was a trend toward improved Block quality in the US group, although not significant.

  • lateral sagittal Infraclavicular Block clinical experience in 380 patients
    Acta Anaesthesiologica Scandinavica, 2008
    Co-Authors: Yavuz Gurkan, Tulay Hosten, Mine Solak, Kamil Toker
    Abstract:

    Background The purpose of this study was to evaluate the clinical utility and Block success rate of 'lateral sagittal Infraclavicular Block (LSIB)' in a large-scale clinical study. Methods Adult patients scheduled for hand, wrist and forearm surgery between March 2005 and June 2007 were prospectively included into the study. Using a nerve stimulator LSIB was performed. In the LSIB technique the puncture site is immediately adjacent to the most medial point of the coracoid process and the anterior surface of the clavicula. The needle is inserted caudally in a sagittal plane, 20 degrees dorsally (downwards), until muscle twitches are observed in synchrony with the stimulation. A Local anesthetic mixture of either 20 ml bupivacaine 5 mg/ml or 20 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml with 5 microg/ml epinephrine (total volume 40 ml) was administered following electrolocation of the median, radial or ulnar nerve. Results Three-hundred and eighty patients were included into the study. Block was successful in 341 (89.7%) patients without any need for local anesthetic supplementation. We had complete failure in 17 (4.5%) patients and these patients received general anesthesia. Twenty-two (5.8%) patients needed either infiltration of local anesthetic at the site of skin incision or supplementation of the Block at the axilla. No other complications other than vascular punctures - 25 patients (6.6%) - were observed. Conclusions LSIB provided a clinically acceptable success rate and our results are in agreement with other studies assessing this approach.

Alexis F Turgeon - One of the best experts on this subject based on the ideXlab platform.

  • ultrasound guided single injection Infraclavicular Block versus ultrasound guided double injection axillary Block a noninferiority randomized controlled trial
    Anesthesia & Analgesia, 2016
    Co-Authors: Ariane Boivin, Mariejosee Nadeau, Nicolas Dion, Simon Levesque, Pierre C Nicole, Alexis F Turgeon
    Abstract:

    BACKGROUND:Single-injection ultrasound-guided Infraclavicular Block is a simple, reliable, and effective technique. A simplified double-injection ultrasound-guided axillary Block technique with a high success rate recently has been described. It has the advantage of being performed in a superficial

  • complications of single injection ultrasound guided Infraclavicular Block a cohort study
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2013
    Co-Authors: Mylene Lecours, Mariejosee Nadeau, Nicolas Dion, Simon Levesque, Annie Dionne, Alexis F Turgeon
    Abstract:

    In recent studies on ultrasound-guided Infraclavicular Block (ICB), the authors have favoured a single injection posterior to the axillary artery rather than multiple injections; however, procedural complications and success rates associated with single-injection ultrasound-guided ICB are not well known. We undertook an observational study to evaluate the success rates of experienced and non-experienced operators performing ICBs and to identify the complications associated with ultrasound-guided single-injection ICB. We conducted an observational cohort study of all ultrasound-guided single-injection ICBs performed over a two-year period (2008-2010). We identified the subjects for our study using a local database and excluded patients younger than 18 yr and those who received a continuous ICB. Complications (non-neurological and neurological) and ICB success rates were the primary and secondary end points, respectively. We collected the following data from patients’ charts: patient demographics, types of complications and their respective frequencies, and the experience of the clinician performing the ICBs, and we identified potential late complications by telephone interview. Using a seven-point Likert scale, two experts in regional anesthesia evaluated the likelihood of a relationship between the identified neurological signs or symptoms and the ICB. A neurologist then evaluated the complications identified as being potentially related to the ICB. Summary data were collated, and 95% confidence intervals (CI) were calculated. We reviewed 627 ICB procedures, and 496 (79%) patients received telephone interviews. Most patients were males who had undergone either plastic or orthopedic surgery. Mepivacaine 1.5% was used in 96% of cases with a median volume of 30 mL [interquartile range 30-38]. We identified 131 cases of neurological signs or symptoms. Four cases were retained as possible links to the ICB, but they underwent complete resolution of symptoms at the time of evaluation. Two possible cases of local anesthetic toxicity were observed. There was a 93% success rate (95% CI 91 to 95) and the results were comparable between the experienced and the non-experienced operators (94% vs 93%, respectively). We observed few complications associated with a single-injection ultrasound-guided ICB and a high success rate regardless of the operator’s expertise. The technique appears to be reliable, easy to perform, and safe.

  • a comparison of a single or triple injection technique for ultrasound guided Infraclavicular Block a prospective randomized controlled study
    Anesthesia & Analgesia, 2009
    Co-Authors: Mariechristine Desgagnes, Mariejosee Nadeau, Nicolas Dion, Simon Levesque, Pierre C Nicole, Jean Brassard, Dany Cote, Alexis F Turgeon
    Abstract:

    BACKGROUND: Good success rates have been reported with ultrasound-guided Infraclavicular Block using one or multiple injections of local anesthetic. We hypothesized that a separate injection of local anesthetics on each cord enhances the onset of complete sensory Block. We designed this prospective randomized study to compare the rate of complete sensory Block using one or three injections of local anesthetic. METHODS: Patients scheduled for hand, wrist, or elbow surgery were included in this study. All Blocks were performed under ultrasound guidance. In Group S (single injection), 30 mL of mepivacaine 1.5% was injected posterior to the axillary artery. In Group T (triple injections), 10 mL of mepivacaine 1.5% was injected on the posterior, medial, and lateral aspects of the axillary artery. Sensory Block was evaluated every 3 min up to 30 min. The primary end point was the rate of complete sensory Block at 15 min. RESULTS: Forty-nine and 51 patients were randomized in Groups S and T, respectively. The rate of complete sensory Block was comparable at 15 min (Group S: 84%, Group T: 78%, P = 0.61) and at each time interval up to 30 min. There was no statistically significant difference in the rate of complications between the two groups. CONCLUSIONS: The success rate and the onset of complete sensory Block after ultrasound-guided Infraclavicular Block are not enhanced by a triple injection of local anesthetic compared with a single injection posterior to the axillary artery.