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

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, Mathieu J.m. Gielen, Hubertus H Spoormans, 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, Mathieu J.m. Gielen, Oliver H G Wildersmith, 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, Mathieu J.m. Gielen, Hubertus H Spoormans, 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, Mathieu J.m. Gielen, Oliver H G Wildersmith, 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.

Harald C Rettig – 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, Mathieu J.m. Gielen, Hubertus H Spoormans, 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, Mathieu J.m. Gielen, Oliver H G Wildersmith, 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.

Jeanmichel Gracies – One of the best experts on this subject based on the ideXlab platform.

  • pathophysiology of spastic Paresis i Paresis and soft tissue changes
    Muscle & Nerve, 2005
    Co-Authors: Jeanmichel Gracies
    Abstract:

    Spastic Paresis follows chronic disruption of the central execution of volitional command. Motor function in patients with spastic Paresis is subjected over time to three fundamental insults, of which the last two are avoidable: (1) the neural insult itself, which causes Paresis, i.e., reduced voluntary motor unit recruitment; (2) the relative immobilization of the paretic body part, commonly imposed by the current care environment, which causes adaptive shortening of the muscles left in a shortened position and joint contracture; and (3) the chronic disuse of the paretic body part, which is typically self-imposed in most patients. Chronic disuse causes plastic rearrangements in the higher centers that further reduce the ability to voluntarily recruit motor units, i.e., that aggravate baseline Paresis. Part I of this review focuses on the pathophysiology of the first two factors causing motor impairment in spastic Paresis: the vicious cycle of Paresis-disuse-Paresis and the contracture in soft tissues.

  • pathophysiology of spastic Paresis ii emergence of muscle overactivity
    Muscle & Nerve, 2005
    Co-Authors: Jeanmichel Gracies
    Abstract:

    In the subacute and chronic stages of spastic Paresis, stretch-sensitive (spastic) muscle overactivity emerges as a third fundamental mechanism of motor impairment, along with Paresis and soft tissue contracture. Part II of this review primarily addresses the pathophysiology of the various forms of spastic overactivity. It is argued that muscle contracture is one of the factors that cause excessive responsiveness to stretch, which in turn aggravates contracture. Excessive responsiveness to stretch also impedes voluntary motor neurneuron recruitment, a concept termed stretch-sensitive Paresis. None of the three mechanisms of impairment (Paresis, contracture, and spastic overactivity) is symmetrically distributed between agonists and antagonists, which generates torque imbalance around joints and limb deformities. Thus, each may be best treated focally on an individual muscle-by-muscle basis. Intensive motor training of the less overactive muscles should disrupt the cycle of Paresis–disuse–Paresis, and concomitant use of aggressive stretch and focal weakening agents in their more overactive and shortened antagonists should break the cycle of overactivity–contracture–overactivity. Muscle Nerve, 2005