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

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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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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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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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