Organizing an AORA Conference: Both Inspiring and Challenging!

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Vol 5 | Issue 1 | January-June 2024 | Page 01-02| Vrushali Ponde

DOI: https://doi.org/10.13107/ijra.2024.v05.i01.082

Authors: Vrushali Ponde [1, 2]

[1] Children’s Anesthesia Services, Mumbai, Maharashtra, India.
[2] AORA India.

Address of Correspondence

Dr. Vrushali Ponde
Chairperson, Board of Studies, AORA India
Founder & Director, Children’s Anesthesia Services, Mumbai, Maharashtra, India.
E-mail: vrushaliponde@yahoo.co.in

Abstract

Oraginzing AORA ((Academy Of Regional Anaesthesia, India ) conferences is inspiring! However, it is also a monumental challenge. This annual event, which is distinguished by its innovative approach, impeccable discipline, and epitome of professionalism, is much more than a collection of lectures, workshops, master classes and yes, the wars.
It is a demonstration of unwavering dedication to the demands of anesthesiologists as well as a sign of AORA’s pride and unity. It ensured an exhaustive coverage of all branches and super-specialties within regional anesthesia.The conference meticulously incorporates two main tracks, including PNS (Peripheral Nerve Stimulation) and USG (Ultrasound Guidance) . Also delves into dedicated symposiums on subspecialties such as obstetric regional anaesthesia, paediatric anaesthesia, chronic pain, and more, However, despite the apparent precision and sophistication of its organization, numerous obstacles continue to exist. These encompass the following:
• Ensuring economic feasibility while fostering genuine industry partnerships,
• Adapting to the evolving landscape of medical education, and
• Balancing the requirements of both faculty and delegates.

Primary Obstacles

Balancing the Needs of Faculty and Delegates:
Although faculty members are essential for the dissemination of knowledge and the exchange of expertise, the conference’s primary focus should be on the delegates. Delegates of the present day possess unparalleled access to online learning platforms and resources. Therefore, the obstacle is to communicate the reasons why attending the AORA conference is an unparalleled experience. It is not solely about acquiring information; it is also about the human connection—including the opportunity to engage with mentors who inspire, participate in seminars that provide hands-on learning, and witness live demonstrations that illustrate real-world scenarios.

Without aspiring students, what would a teacher do? And without a mentor eager to share, where does a student truly learn? Both are indispensable in the journey of growth and upliftment

Human Element vs. Digital Learning:
In a time when digital learning is ubiquitous, the significance of human interaction in education is immeasurable. An opportunity to engage in face-to-face discussions, connect personally with experts, and witness live demonstrations of both successes and failures is provided by the AORA conference, which online platforms are unable to completely replicate. This human touch—understanding vulnerabilities and learning from real-time examples—adds a layer of substance to professional development that digital media alone cannot provide.
Online information is valuable, but in the presence of masters and experts, knowledge and inspiration truly bloom

Economic Factors:
The organization of a conference of this magnitude necessitates a substantial financial investment. It is essential to achieve a balance between managing costs and maintaining high standards. Mitigating economic pressures can be achieved by establishing robust, authentic partnerships with industry sponsors and comprehending their needs. These partnerships are not solely transactional; rather, they should be founded on mutual benefit and collaboration, guaranteeing that both parties benefit from the association.

Trade and education are not merely a give and take; this connection fosters something unique—a mutual understanding and a profound realization that both are interdependent.

Inquiries for Introspection

What are some ways in which we can improve the conference experience to offer more value than what is currently available online?
It is imperative to emphasize the distinctive features of the conference that digital platforms are unable to provide, including
• Networking opportunities,
• Real-time problem-solving, and
• Live interactions with thought leaders.
What is the most effective method for conveying the distinction between information and inspiration to delegates?
The conference provides inspiration through mentorship and real-world applications of knowledge, while online resources provide information. Delegates must comprehend this distinction.

What strategies can we implement to guarantee that the conference maintains its quality while remaining economically viable?
Exploring innovative funding models, forming strategic partnerships, and optimizing resource allocation can help achieve this balance. Perhaps, keeping it for a shorter duration!, Consideration of a shorter duration could enhance the conference’s effectiveness, making it more focused and impactful.

In summary, the organization of an AORA conference is a multifaceted undertaking that extends beyond academic content and logistical planning. It necessitates a strategic approach to economic management, an appreciation for the nuances of live learning, and a profound comprehension of the human factors that drive professional development. By thoughtfully and creatively addressing these challenges, we can maintain the AORA conference as a groundbreaking event that embodies the essence of excellence in regional anesthesia.

 

Regards,
Dr. Vrushali Ponde
Chairperson, Board of Studies, AORA India.
Founder & Director, Children’s Anesthesia Services, Mumbai, Maharashtra, India.

How to Cite this Article:  Ponde V | Organizing an AORA Conference: Both Inspiring and Challenging! | International Journal of Regional Anaesthesia | January-June 2024; 5(1): 01-02 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.82

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Are We Depleted of Research Questions in Regional Anaesthesia?

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Vol 5 | Issue 1 | January-June 2024 | Page 03-06| Divesh Arora

DOI: https://doi.org/10.13107/ijra.2024.v05.i01.083

Authors: Anju Grewal [1], Gegal Pruthi [1], Hemanthkumar Tamilchelva [1]

[1] Department of Anaesthesiology, AIIMS, Bathinda, Punjab, India

Address of Correspondence

Dr. Gegal Pruthi,
Department of Anaesthesiology, AIIMS, Bathinda, Punjab, India
E-mail: drpkc12@gmail.com

Abstract

Regional anaesthesia has significantly evolved, shaping pain management in surgery. This article examines whether research question in this field are becoming exhausted, or if new avenues remain unexplored. Key trends include the integration of ultrasound guidance for precision, optimizing drug combinations for enhanced safety and efficacy, and focusing on patient-concerned outcomes to improve satisfaction and recovery. Tailored approaches for special populations and long-term safety studies are also crucial. Future research may explore innovations in drug delivery, novel local anaesthetic adjuncts, neurostimulation techniques, global access, interdisciplinary collaborations, and the application of artificial intelligence. Emphasizing simplicity, innovation, and patient centric care will ensure continued progress in regional anaesthesia, fostering advancement that enhance both scientific knowledge and clinical practices.
Keywords: Pain management, Regional anaesthesia, Research trends

References

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(2) COVIDSurg Collaborative, GlobalSurg Collaborative, Nepogodiev D, Simoes JF, Li E, Picciochi M, Glasbey JC, Baiocchi G, Blanco‐Colino R, Chaudhry D, AlAmeer E. Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study. Anaesthesia. 2021 Jun;76(6):748-58.
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(4) Beverly A, Kaye AD, Ljungqvist O, Urman RD. Essential elements of multimodal analgesia in enhanced recovery after surgery (ERAS) guidelines. Anesthesiology clinics. 2017 Jun 1;35(2):e115-43.
(5) Yun JS, Chung MJ, Kim HR, So JI, Park JE, Oh HM, Lee JI. Accuracy of needle placement in cadavers: non-guided versus ultrasound-guided. Annals of rehabilitation medicine. 2015 Apr 24;39(2):163-9.
(6) Johnson AN, Peiffer JS, Halmann N, Delaney L, Owen CA, Hersh J. Ultrasound-Guided needle technique accuracy: prospective comparison of passive magnetic tracking versus unassisted echogenic needle localization. Regional Anesthesia & Pain Medicine. 2017 Mar 1;42(2):223-32.
(7) Wu CL, Fleisher LA. Outcomes research in regional anesthesia and analgesia. Anesthesia & Analgesia. 2000 Nov 1;91(5):1232-42.
(8) Turbitt LR, Mariano ER, El‐Boghdadly K. Future directions in regional anaesthesia: not just for the cognoscenti. Anaesthesia. 2020 Mar;75(3):293-7.
(9) Gadsden J, Orebaugh S. Targeted intracluster supraclavicular brachial plexus block: too close for comfort. British Journal of Anaesthesia. 2019 Jun 1;122(6):713-5.
(10) Desai N, Kirkham KR, Albrecht E. Local anaesthetic adjuncts for peripheral regional anaesthesia: a narrative review. Anaesthesia. 2021 Jan;76:100-9.
(11) Kurdi MS, Agrawal P, Thakkar P, Arora D, Barde SM, Eswaran K. Recent advancements in regional anaesthesia. Indian Journal of Anaesthesia. 2023 Jan;67(1):63.
(12) Bowness J, Varsou O, Turbitt L, Burkett‐St Laurent D. Identifying anatomical structures on ultrasound: assistive artificial intelligence in ultrasound‐guided regional anesthesia. Clinical Anatomy. 2021 Jul;34(5):802-9.

How to Cite this Article: Grewal A, Pruthi G, Tamilchelva H | Are We Depleted of Research Questions in Regional Anaesthesia? | International Journal of Regional Anaesthesia | January-June 2024; 5(1): 03-06 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.83

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Ultrasound: Ankle and Foot Blocks

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Vol 5 | Issue 1 | January-June 2024 | Page 07-13| Divesh Arora

DOI: https://doi.org/10.13107/ijra.2024.v05.i01.084

Authors: Divesh Arora [1]

[1] Anaesthesia & OT Services, Asian Hospital, Faridabad, Haryana, India.

Address of Correspondence

Dr. Divesh Arora,
Director & HOD, Anaesthesia & OT Services, Asian Hospital, Faridabad, Haryana, India.
E-mail: drdivesh@gmail.com

Abstract

Ankle blocks are regional anaesthetic techniques used for foot surgery and pain management. Traditionally performed with anatomical landmarks, ultrasound-guided ankle and foot blocks have emerged as a pivotal technique in regional anaesthesia, offering enhanced precision and safety over traditional methods. This review article examines the current practices in ultrasound-guided ankle and foot blocks, including the necessary equipment, sonoanatomy, and injection techniques for various nerves. This comprehensive review aims to equip anaesthesiologists with the knowledge to effectively implement ultrasound-guided ankle and foot blocks, ultimately optimizing pain management and procedural success in lower extremity interventions.
Keywords: Ankle block, Ultrasound guidance, Foot and ankle surgery

References

1. Han JR, Tran J, Agur AM. Overview of the Innervation of Ankle Joint. Physical Medicine and Rehabilitation Clinics. 2021 Nov 1;32(4):791-801.
2. Moosa F, Allan A, Bedforth N. Regional anaesthesia for foot and ankle surgery. BJA education. 2022 Nov 1;22(11):424-31.
3. Sharrow CM, Elmore B. Anesthesia for the Patient Undergoing Foot and Ankle Surgery. Clinics in Sports Medicine. 2022 Apr 1;41(2):263-80.
4. Madhavi C, Isaac B, Antoniswamy B, Holla SJ. Anatomical variations of the cutaneous innervation patterns of the sural nerve on the dorsum of the foot. Clinical Anatomy: The Official Journal of the American Association of Clinical Anatomists and the British Association of Clinical Anatomists. 2005 Apr;18(3):206-9.
5. Mercer D, Morrell NT, Fitzpatrick J, Silva S, Child Z, Miller R, DeCoster TA. The course of the distal saphenous nerve: a cadaveric investigation and clinical implications. The Iowa orthopaedic journal. 2011;31:231.
6. López AM, Sala-Blanch X, Magaldi M, Poggio D, Asuncion J, Franco CD. Ultrasound-guided ankle block for forefoot surgery: the contribution of the saphenous nerve. Regional Anesthesia & Pain Medicine. 2012 Sep 1;37(5):554-7.
7. Gbejuade H, Squire J, Dixit A, Kaushik V, Mangwani J. Ultrasound-guided regional anaesthesia in foot and ankle surgery. Journal of Clinical Orthopaedics and Trauma. 2020 May 1;11(3):417-21.
8. Korwin-Kochanowska K, Potié A, El-Boghdadly K, Rawal N, Joshi G, Albrecht E. PROSPECT guideline for hallux valgus repair surgery: a systematic review and procedure‐specific postoperative pain management recommendations. Regional Anesthesia & Pain Medicine. 2020 Sep 1;45(9):702-8.
9. Lee M, Lee C, Lim J, Kim H, Choi YS, Kang H. Comparison of a Peripheral Nerve Block versus Spinal Anesthesia in Foot or Ankle Surgery: A Systematic Review and Meta-Analysis with a Trial Sequential Analysis. Journal of Personalized Medicine. 2023 Jul 4;13(7):1096.
10. Schipper ON, Hunt KJ, Anderson RB, Davis WH, Jones CP, Cohen BE. Ankle block vs single-shot popliteal fossa block as primary anesthesia for forefoot operative procedures: prospective, randomized comparison. Foot & ankle international. 2017 Nov;38(11):1188-91.
11. Roberts VI, Aujla RS, Fombon FN, Singh H, Bhatia M. Is regional ankle block needed in conjunction with general anaesthesia for first ray surgery? A randomised controlled trial of ultrasound guided ankle block versus “blind” local infiltration. Foot and Ankle Surgery. 2020 Jan 1;26(1):66-70.
12. Chin KJ, Wong NW, Macfarlane AJ, Chan VW. Ultrasound-guided versus anatomic landmark-guided ankle blocks: a 6-year retrospective review. Regional Anesthesia & Pain Medicine. 2011 Oct 1;36(6):611-8.
13. Redborg KE, Antonakakis JG, Beach ML, Chinn CD, Sites BD. Ultrasound improves the success rate of a tibial nerve block at the ankle. Regional Anesthesia & Pain Medicine. 2009 Apr 1;34(3):256-60.
14. Redborg KE, Sites BD, Chinn CD, Gallagher JD, Ball PA, Antonakakis JG, Beach ML. Ultrasound improves the success rate of a sural nerve block at the ankle. Regional Anesthesia & Pain Medicine. 2009 Jan 1;34(1):24-8.
15. Antonakakis JG, Scalzo DC, Jorgenson AS, Figg KK, Ting P, Zuo Z, Sites BD. Ultrasound does not improve the success rate of a deep peroneal nerve block at the ankle. Regional Anesthesia & Pain Medicine. 2010 Feb 1;35(2):217-21.
16. Lee JK, Lee GS, Kim SB, Kang C, Kim KS, Song JH. A Comparative Analysis of Pain Control Methods after Ankle Fracture Surgery with a Peripheral Nerve Block: A Single-Center Randomized Controlled Prospective Study. Medicina. 2023 Jul 14;59(7):1302.
17. Marty P, Rontes O, Chassery C, Vuillaume C, Basset B, Merouani M, Marquis C, Bataille B, Chaubard M, Mailles MC, Ferré F. Perineural versus systemic dexamethasone in front-foot surgery under ankle block: a randomized double-blind study. Regional Anesthesia & Pain Medicine. 2018 Oct 1;43(7):732-7.
18. Dawson RL, McLeod DH, Koerber JP, Plummer JL, Dracopoulos GC. A randomised controlled trial of perineural vs intravenous dexamethasone for foot surgery. Anaesthesia. 2016 Mar;71(3):285-90.
19. Kahn RL, Ellis SJ, Cheng J, Curren J, Fields KG, Roberts MM, YaDeau JT. The incidence of complications is low following foot and ankle surgery for which peripheral nerve blocks are used for postoperative pain management. HSS Journal®. 2018 Jul;14(2):134-42.
20. Lauf JA, Huggins P, Long J, Mohammed AI, Byrne B, Large BP, Whitehead B, Cheney NA, Law Sr TD. Regional nerve block complication analysis following peripheral nerve block during foot and ankle surgical procedures. Cureus. 2020 Jul 28;12(7).

How to Cite this Article: Arora D | Ultrasound: Ankle and Foot Blocks | International Journal of Regional Anaesthesia | January-June 2024; 5(1): 07-13 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.84

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USG Guided Lumbosacral Plexus Block for Surgery for Fracture Hip in High-Risk Patients– A Retrospective Case Series

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Vol 5 | Issue 1 | January-June 2024 | Page 14-17| Harshal D Wagh , Chetan Salunkhe , Mitalee Pareek , Senthil Kumar

DOI: https://doi.org/10.13107/ijra.2024.v05.i01.085

Authors: Harshal D Wagh [1], Chetan Salunkhe [1], Mitalee Pareek [1], Senthil Kumar [1]

 

[1] Department of Anaesthesia, Kokilaben Dirubhai Ambani Hospital, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Mitalee Pareek
Department of Anaesthesia, Kokilaben Dirubhai Ambani Hospital, Mumbai, Maharashtra, India.
E-mail: pareekmitalee@gmail.com

Abstract

Background 1.6 million patients worldwide are victims of hip fracture. The incidence is expected to rise with ageing of world’s population. Elderly patients with hip fracture pose a medical challenge for the anesthesiologist and are often associated with high incidence of morbidity and mortality. Early surgical fixation of fractured joint is necessary to reduce associated morbidity. Advanced age and delayed surgical correction and medical history are independent factors determining 1 year mortality after hip fixation which is 23.9% in these patients.

Objective: In this case series where we share our experience of fracture femur fixation performed under USG guided combined lumbosacral block for 19 patients of ASA 3/4 physical status.

Method: Hip fracture fixation was performed under USG guided and neurostimulation technique Lumbar plexus and Para-sacral sciatic nerve block with 20 ml and 15 ml of 0.3% Ropivacaine respectively. All patients were shifted to ICU for further care.

Conclusion: USG guided Lumbosacral plexus block for surgeries around the hip joint can be used as a sole anesthetic in high-risk patients. Detailed preoperative evaluation and optimization, vigilant patient selection, counselling, monitoring, providing optimum drug dosage are key for success.

Keywords: Lumbosacral plexus block, Hip fracture, USG-guided

References

1] Ahamed Z A, Sreejit MS. Lumbar plexus block as an effective alternative to subarachnoid block for intertrochanteric hip fracture surgeries in the elderly. Anesth Essays Res 2019;13:264-8
2] Diwan S, Pradhan C, Patil A, Puram C, Sancheti P. Combined lumbar and sacral plexus block in geriatric high-risk patients undergoing an awake repair of fracture intertrochanteric of femur. Journal of Anaesthesia and Critical Care Case Reports Jan-April 2018; 4(1):21-30
3] Mannion S, Barrett J, Kelly D, Murphy DB, Shorten GD. A description of the spread of injectate after psoas compartment block using magnetic resonance imaging. Reg Anesth Pain Med. 2005 Nov-Dec;30(6):567-71. doi: 10.1016/j.rapm.2005.08.004. PMID: 16326342.
4] Parkinson SK, Mueller JB, Little WL, Bailey SL. Extent of blockade with various approaches to the lumbar plexus. Anesth Analg. 1989 Mar;68(3):243-8. PMID: 2919761
5] Capdevila X, Macaire P, Dadure C, Choquet O, Biboulet P, Ryckwaert Y, D’Athis F. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation. Anesth Analg. 2002 Jun;94(6):1606-13, table of contents. doi: 10.1097/00000539-200206000-00045. PMID: 12032037.
6] Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Peña M, Alonso-Blas C, García-Vadillo A, Mazzucchelli R. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res. 2019 Jul 4;14(1):203. doi: 10.1186/s13018-019-1226-6. PMID: 31272470; PMCID: PMC6610901.
7] Morri M, Ambrosi E, Chiari P, Orlandi Magli A, Gazineo D, D’ Alessandro F, Forni C. One-year mortality after hip fracture surgery and prognostic factors: a prospective cohort study. Sci Rep. 2019 Dec 10;9(1):18718. doi: 10.1038/s41598-019-55196-6. PMID: 31822743; PMCID: PMC6904473.
8] Zhang J, Wang X, Zhang H, Shu Z, Jiang W. Comparison of combined lumbar and sacral plexus block with sedation versus general anaesthesia on postoperative outcomes in elderly patients undergoing hip fracture surgery (CLSB-HIPELD): study protocol for a prospective, multicentre, randomised controlled trial. BMJ Open. 2019 Mar 30;9(3):e022898. doi: 10.1136/bmjopen-2018-022898. PMID: 30928924; PMCID: PMC6475153.
9] Honorio T. Benzon, Rasha S. Jabri, and Tom C. Van Zundert Neuraxial Anesthesia and Peripheral Nerve Blocks in Patients on Anticoagulants. https://www.nysora.com/foundations-of-regional-anesthesia/patient-management/neuraxial-anesthesia-peripheral-nerve-blocks-patients-anticoagulants/
10] Nielsen MV, Bendtsen TF, Børglum J. Superiority of ultrasound-guided Shamrock lumbar plexus block. Minerva Anestesiol. 2018 Jan;84(1):115-121. doi: 10.23736/S0375-9393.17.11783-9. Epub 2017 Jul 26. PMID: 28749094.
11] Taha AM. A simple and successful sonographic technique to identify the sciatic nerve in the parasacral area. Can J Anaesth. 2012 Mar;59(3):263-7. doi: 10.1007/s12630-011-9630-3. Epub 2011 Dec 3. PMID: 22139964.
12] Bendtsen TF, Lönnqvist PA, Jepsen KV, Petersen M, Knudsen L, Børglum J. Preliminary results of a new ultrasound-guided approach to block the sacral plexus: the parasacral parallel shift. Br J Anaesth. 2011 Aug;107(2):278-80. doi: 10.1093/bja/aer216. PMID: 21757560.
13] Huette P, Abou-Arab O, Djebara AE, Terrasi B, Beyls C, Guinot PG, Havet E, Dupont H, Lorne E, Ntouba A, Mahjoub Y. Risk factors and mortality of patients undergoing hip fracture surgery: a one-year follow-up study. Sci Rep. 2020 Jun 15;10(1):9607. doi: 10.1038/s41598-020-66614-5. PMID: 32541939; PMCID: PMC7296002.
14] Uma Shastri, Kwesi Kwofie, Emine Aysu Salviz, Daquan Xu, Admir Hadzic. 54 – Lower Extremity Nerve Blocks,Editor(s): Honorio T. Benzon, James P. Rathmell, Christopher L. Wu, Dennis C. Turk, Charles E. Argoff, Robert W. Hurley, Practical Management of Pain (Fifth Edition)2014, Pages 732-744.e2, https://doi.org/10.1016/B978-0-323-08340-9.00054-2.

How to Cite this Article: Wagh HD, Salunkhe C, Pareek M, Kumar S | USG Guided Lumbosacral Plexus Block for Surgery for Fracture Hip in High-Risk Patients– A Retrospective Case Series Block | International Journal of Regional Anaesthesia | January-June 2024; 5(1): 14-17 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.85

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Incidence of Hemidiaphragmatic Paralysis After Ultrasound Guided Low Dose Interscalene Brachial Plexus Block

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Vol 5 | Issue 1 | January-June 2024 | Page 18-23| Tanvir Samra, Pankaj Kushal, Vikas Saini, Sameer Sethi, Rahul Kathuria, Anjuman Chander

DOI: https://doi.org/10.13107/ijra.2024.v05.i01.086

Authors: Tanvir Samra [1], Pankaj Kushal [1], Vikas Saini [1], Sameer Sethi [1], Rahul Kathuria [2], Anjuman Chander [1]

 

[1] Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
[2] Department of Anaesthesia, Park Hospital, Ambala, Haryana, India.

Address of Correspondence

Dr. Anjuman Chander,
Department of Anaesthesia, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
E-mail: Achander08@gmail.com

Abstract

Background and Aims: Hemidiaphragmatic paralysis is a complication of single shot and continuous interscalene brachial plexus block that can be minimised by ultrasound guided extra fascial catheter placements and by limiting the amount of local anaesthetic administered. In this study, we report incidence of hemidiaphragmatic paralysis with patient-controlled infusion of low volume of ropivacaine after ultrasound guided low dose interscalene brachial plexus block (LD-ISB).
Methods: Patients aged 18-65 years undergoing surgery for shoulder dislocation or proximal humerus fracture were recruited and administered general anaesthesia. Before extubation ultrasound guided LD-ISB (10 ml of 0.5% ropivacaine) was administered and a catheter tunneled so that patient controlled interscalene analgesia (PCIA) could be given with low volume ropivacaine. PCIA was initiated after four hours in the post operative recovery to deliver background infusion of 2 ml/h, bolus of 5ml (0.2% of ropivacaine) with lockout interval of 30 minutes for a total duration of 24 hours. Incidence of hemidiaphragmatic paralysis was recorded at extubation using M-mode ultrasonography. Before start of PCIA i.e. at 4 hours and after start of PCIA i.e. 6,12 and 24 h after extubation.
Results: PCIA after LD-ISB was administered to 29 patients. Subsequently, two patients were excluded due to catheter dislodgement. The incidence of complete and partial paresis of diaphragm after extubation was 85% and 3.7% with LD-ISB respectively but was resolved before start of PCIA i.e., at 4 hours. Thus, at time of commencement of PCIA all patients had normal diaphragmatic excursions and subsequently at 6,12 and 24 h no paresis/paralysis was reported in patients administered only the background infusion or an additional single bolus dose of ropivacaine with the background infusion. Partial paresis was noted in all patients in which two bolus doses/h were administered. All patients with paresis had diaphragmatic excursion normalised in the next recording made at 4 hours and no complication was reported in any patient. VAS (Visual Analog Scale) was below 3 at all time points.
Conclusion: Partial/complete paresis after a single shot injection of 10 ml of 0.5% ropivacaine resolves in 4 hours. PCIA initiated after it for subsequent 20 hours with a single bolus dose of 5ml of 0.2% ropivacaine and background infusion at 2 ml/h does not cause phrenic paresis. Partial paresis is reported with two bolus doses/h, but it is clinically asymptomatic. Thus, the above dose regimes are safe and effective in managing post-operative pain.
Keywords: Interscalene block, Diaphragmatic paresis, Ropivacaine, continuous infusion, Analgesic efficacy

References

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10. Diwan S, Nair A, Adhye B, Sancheti P. Continuous incremental interscalene block for proximal humerus in patients with severe pulmonary injury. Indian J Anaesth. 2022 ;66:460-463.
11. Lang J, Cui X, Zhang J, Huang Y. Dyspnea induced by hemidiaphragmatic paralysis after ultrasound-guided supraclavicular brachial plexus block in a morbidly obese patient. Medicine (Baltimore). 2022;101:28525.
12. Liu Y, Xu C, Wang C, Gu F, Chen R, Lu J. Median Effective Analgesic Concentration of Ropivacaine in Ultrasound-Guided Interscalene Brachial Plexus Block as a Postoperative Analgesia for Proximal Humerus Fracture: A Prospective Double-Blind Up-Down Concentration-Finding Study. Front Med (Lausanne). 2022;9:857427.
13. Khurana J, Gartner SC, Naik L, Tsui BCH. Ultrasound Identification of Diaphragm by Novices Using ABCDE Technique. Reg Anesth Pain Med. 2018;43:161-165.
14. Sripriya R, Manisha Gupta J, Arthi PR, Parthasarathy S. Ultrasound measurement of the distance of the phrenic nerve from the brachial plexus at the classic interscalene point and upper trunk: A volunteer-based observational study. Indian J Anaesth. 2023 ;67:457-462.
15. Robles C, Berardone N, Orebaugh S. Effect of superior trunk block on diaphragm function and respiratory parameters after shoulder surgery. Reg Anesth Pain Med. 2022 ;47:167-170.
16. Srinivasan KK, Ryan J, Snyman L, O’Brien C, Shortt C. Can saline injection protect phrenic nerve? – A randomised controlled study. Indian J Anaesth. 2021;65:445-450.
17. Ngai LK, Ma W, Costouros JG, Cheung EV, Horn JL, Tsui BCH. Successful reversal of phrenic nerve blockade following washout of interscalene nerve block as demonstrated by ultrasonographic diaphragmatic excursion. J Clin Anesth. 2020 ;59:46-48.
18. Smith LM, Barrington MJ. A novel approach to reversal of respiratory distress following insertion of an interscalene nerve catheter. J Clin Anesth. 2018;47:43-44.

How to Cite this Article: Samra T, Kushal P, Saini V, Sethi S, Kathuria R, Chander A | Incidence of Hemidiaphragmatic Paralysis After Ultrasound Guided Low Dose Interscalene Brachial Plexus Block | International Journal of Regional Anaesthesia | Januar y-June 2024; 5(1): 18-23 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.86

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Effectiveness of Using Ultrasound-Inferior Venacava Collapsibility Index (IVCCI) as a Guidance Tool for Resuscitating the Patients Undergoing Emergency Lower Limb Orthopaedic Surgeries Under Spinal Anaesthesia

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Vol 5 | Issue 1 | January-June 2024 | Page 24-29| S. Narmatha Yangste, S. Shankar Raju, Bhaskar

DOI: https://doi.org/10.13107/ijra.2024.v05.i01.087

Authors: S. Narmatha Yangste [1], S. Shankar Raju [2], Bhaskar [3]

[1] Department of Anesthesiology, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India.
[2] Department of Anesthesiology, ESI medical college, Coimbatore, Tamil Nadu, India.
[3] Department of Anesthesiology, Dharmapuri Medical College, Dharmapuri, Tamil Nadu, India.

Address of Correspondence
Dr. S. Narmatha Yangste,
Associate Professor, Department of Anesthesiology, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India.
E-mail: nyangtse75@gmail.com

Abstract

Background and Aim: Ultrasound-guided inferior vena cava collapsibility index (IVCCI) is used for assessing the volume status of the patient in critical care but for emergency cases taken up under spinal anesthesia this index helps to assess the adequacy of resuscitation. In our study, we aimed to evaluate the usefulness of ultrasound in adequately resuscitating patients requiring subarachnoid block for emergency lower limb orthopedic surgeries.
Methods: After obtaining approval from the Coimbatore Medical College institutional ethical committee, 60 adults aged between 20 and 60 comprising both sexes requiring emergency lower limb [shaft of femur] orthopedics surgeries were included in this randomized clinical study. After a complete pre-anaesthetic assessment, IVCCI by ultrasound is measured. The patient was resuscitated to a target IVCCI of ≤30% before performing the subarachnoid block from the USG group. The other group of patients was resuscitated till the mean arterial pressure (MAP) was≥65 mm Hg from the MAP group. Then spinal anaesthesia was performed in a sitting position via L3 – L4 interspace using a 25 G Quincke’s needle. The parameters were monitored every 5 minutes for 30 minutes post-spinal.
Results: The incidence and severity of hypotension are lesser in the ultrasound group compared to the MAP group which was statistically significant (p=0.004).
Conclusion: Our study concludes that the USG-guided fluid resuscitation with a target IVCCI ≤30% for emergency surgeries under spinal anaesthesia does reduce the severity of hypotension and its adverse outcomes.
Keywords: Inferior vena cava, Lower limb, Fracture, Mean arterial pressure, Ultrasound, Spinal anesthesia

References

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2) Ceruti S, Anselmi L, Minotti B, Franceschini D, Aguirre J, Borgeat A, Saporito A. Prevention of arterial hypotension after spinal anaesthesia using vena cava ultrasound to guide fluid management. Br J Anaesth. 2018 Jan;120(1):101-108. doi: 10.1016/j.bja.2017.08.001. Epub 2017 Nov 23. PMID: 29397116.
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How to Cite this Article: Raju SS, Yangste SN, Kalyanasundaram K | Effectiveness of Using Ultrasound-Inferior Venacava Collapsibility Index (IVCCI) as a Guidance Tool for Resuscitating the Patients Undergoing Emergency Lower Limb Orthopaedic Surgeries Under Spinal Anaesthesia | International Journal of Regional Anaesthesia | January-June 2024; 5(1): 24-29 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.87

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Anomalous Brachial Plexus and their Relationship to the Subclavian Artery in the Supraclavicular Region

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Vol 5 | Issue 1 | January-June 2024 | Page 30-31| Pooja Jadhao, Sandeep Diwan

DOI: https://doi.org/10.13107/ijra.2024.v05.i01.088

Authors: Pooja Jadhao [1], Sandeep Diwan [1]

[1] Department of Anaesthesiology, Sancheti Hospital and Rehabilitation Centre, Pune, Maharashtra, India.

Address of Correspondence
Dr. Pooja Jadhao,
Department of Anaesthesiology, Sancheti Hospital and Rehabilitation Centre, Pune, Maharashtra, India.
E-mail: poojajadhao533@gmail.com

Abstract

The brachial plexus at supraclavicular division level is superior and lateral to the subclavian artery. Thus needle tip positions are already published in literature. However we report the brachial plexus divisions on the medial side of the subclavian artery. This might result in inadequate or failed blocks with landmark guided technique. Moreover with ultrasound needle tip needs to advance medial to artery making it more difficult in expert hands too. Ultrasound imaging of brachial plexus helps in identifying anamolous position of brachial plexus divisions.
Keywords- Brachial plexus divisions, Subclavian artery, Ultrasound

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How to Cite this Article: Jadhao P, Diwan S | Anomalous Brachial Plexus and their Relationship to the Subclavian Artery in the Supraclavicular Region | International Journal of Regional Anaesthesia | January-June 2024; 5(1): 30-31 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.88

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