Ultrasound Guided Peripheral Nerve Block For Lower Limb Fracture Fixation In A Patient With Hypertrophied Obstructive Cardiomyopathy (HOCM)

Vol 5 | Issue 2 | July-December 2024 | Page 10-12| Pratik Bhange, Shruti Patil, Deepali Thakur

DOI: https://doi.org/10.13107/ijra.2024.v05.i02.96

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted: February 02-07-2024; Reviewed: 01-08-2024; Accepted: 22-07-2024; Published: 10-12-2024


Authors: Pratik Bhange [1], Shruti Patil [1], Deepali Thakur [1]

[1] Department of Anaesthesiology, LTMMC & GH, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Pratik Bhange,
Department of Anaesthesiology, LTMMC & GH, Mumbai, Maharashtra, India
E-mail: pratikbhange96@gmail.com


Abstract

The presentation of hypertrophic obstructive cardiomyopathy may vary from an asymptomatic patient to sudden death. The changes in preload, afterload and ventricular contractility may occur due to surgery, anaesthesia and fluid shifts in the perioperative period. This causes worsening of the left ventricular outflow tract obstruction, ultimately causing myocardial ischemia and cardiac dysrhythmias. This case discusses successful anaesthesia management of a 49-year-old male with hypertrophic obstructive cardiomyopathy operated for tibia and fibula open reduction, internal fixation using ultrasound-guided sciatic and femoral nerve block. Transthoracic Echocardiography served as an additional monitoring modality to assess cardiac function intraoperatively. The patient underwent successful surgery with stable hemodynamics and reported excellent pain relief postoperatively.
Keywords: Hypertrophic obstructive cardiomyopathy, Transthoracic Echocardiography, Peripheral nerve block


References


1. Hensley N, Dietrich J, Nyhan D, Mitter N, Yee M; Brady M. Hypertrophic Cardiomyopathy: A Review. Anesthesia& Analgesia.2015;120:554-569
2. Ibrahim R, Sharma V. Cardiomyopathy and anaesthesia. BJA Education. 2017;17:363–369.
3. Thompson R, Liberthson R, Lowenstein E. Perioperative Anesthetic Risk of Noncardiac Surgery in Hypertrophic Obstructive Cardiomyopathy. JAMA.1985;254:2419–2421
4. Mitra M, Basu M, Shailendra K, Jain C. Use of Peripheral Nerve Blocks in Perioperative Management of Cases with Hypertrophic Cardiomyopathy Undergoing Lower Limb Orthopedic Surgeries. Anesth Essays Res. 2020;14:277-282.
5. Cunningham J, Braun S, Hussey P, et al. (February 08, 2024) Regional Anesthesia for Arthroscopic Knee Repair in a Patient With Hypertrophic Obstructive Cardiomyopathy (HOCM) Under Monitored Anesthesia Care With Dexmedetomidine Infusion. Cureus 2024;16: e53862
6. Sahoo, Rajendra K et al. “Perioperative anesthetic management of patients with hypertrophic cardiomyopathy for noncardiac surgery: a case series.” Annals of cardiac anaesthesia .2010;13: 253-6.
7. Kang R, Chung Y, Yang M, Choi D. Reduced Hemidiaphragmatic Paresis With a “Corner Pocket” Technique for Supraclavicular Brachial Plexus Block iSingle-Center, Observer-Blinded, Randomized Controlled Trial. Regional Anesthesia &Pain Medicine 2018;43: 720–724
8. Prabhavathi, Ravipati et al. “Lithotripsy under low dose spinal anaesthesia with dexmedetomidine in a patient with hypertrophic obstructive cardiomyopathy.” Indian journal of anaesthesia 2014;58:360-2.
9. Sahoo R, Dash S, Raut P, Badole U, Upasani C. Peri‑operative Anaesthetic management of patients with hypertrophic cardiomyopathy for noncardiac surgery: A case series. Ann Card Anaesth 2010;13:253‑6.
10. Gregory S, & Fierro, M. The role of intraoperative transesophageal echocardiographic monitoring in a patient with hypertrophic cardiomyopathy undergoing laparoscopic surgery. Journal of Clinical Anesthesia.2016;34:124–127.


How to Cite this Article: Bhange P, Patil S, Thakur D | Ultrasound Guided Peripheral Nerve Block For Lower Limb Fracture Fixation In A Patient With Hypertrophied Obstructive Cardiomyopathy (HOCM) | International Journal of Regional Anaesthesia | July-December 2024; 5(2): 13-15 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.96


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A Case Report on Bilateral Ultrasound Guided Brachial Plexus Block in a Paediatric Patient with Unusual Congenital Anomalies

Vol 5 | Issue 2 | July-December 2024 | Page 27-30 | Anupama Triparhi Srikanth, Pooja Patil, Anitha Pramod, Srikanth V

DOI: https://doi.org/10.13107/ijra.2024.v05.i02.104

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted: February 10-07-2024; Reviewed: 02-08-2024; Accepted: 03-10-2024; Published: 10-12-2024


Authors: Anupama Triparhi Srikanth [1], Pooja Patil [1], Anitha Pramod [1], Srikanth V [1]

[1] Department of Anaesthesiology, Manipal Hospitals, Old airport road, Bangalore, Karnataka, India.

Address of Correspondence

Dr. Pooja Patil
Department of Anaesthesiology, Manipal Hospitals, Old airport road, Bangalore, Karnataka, India.
Email id: patil24992pooja@gmail.com


Abstract

Background: Performing bilateral brachial plexus blocks (BPB) in paediatric patients is a rare practice due to concerns like diaphragmatic paralysis, local anaesthetic systemic toxicity, pneumothorax and hematoma formation. The introduction of ultrasound in regional anaesthesia has revolutionized precision, allowing reduced local anaesthetic doses and increased success rates.
Case Description: We present the case of an 11-year-old male, who underwent uneventful surgical repair for Tetralogy of Fallot at 8 months of age, posted for right index finger pollicization and left-hand distractor frame application. Auscultatory finding of loud S2 and ejection systolic murmur corroborated with echo finding of mild pulmonary regurgitation, intact VSD patch, and good biventricular function. After administering general anaesthesia with controlled ventilation, ultrasound-guided axillary approach bilateral BPB with 11 ml 0.33% Ropivacaine (equal volume mixture of 0.5% and 0.2% Ropivacaine after calculation of maximum allowable dose) was given sequentially on each side with an interval of 2.5 hours. The overall outcome was safe and uneventful.
Discussion: According to the Pediatric Regional Anaesthesia Network, only 3% of all regional anaesthetics (RA) in children involve upper limb blocks. Literature supporting bilateral BPB in children is scarce. RA improves haemodynamic stability, reduces the incidence of postoperative respiratory complications, decreases catecholamine production and the metabolic stress response to surgery and promotes a fast return of gut function and feeding, all of which benefited this child with known cardiac comorbidity. Improvement in the accuracy of ultrasound imaging has undoubtedly boosted regional anaesthetic techniques making nerve blocks safe and well tolerated in children.
Conclusion: Our case report demonstrates successful incorporation of US guided bilateral axillary brachial plexus block in a child with preexisting cardiac illness coming for major upper limb surgeries resulting in a painfree child, satisfied parents and happy surgeons.
Keywords: Bilateral brachial plexus blocks (BPB), Pediatric Regional Anaesthesia, Ultrasound.


References


1. Polaner DM, Taenzer AH, Walker BJ, Bosenberg A, Krane EJ, Suresh S, Wolf C, Martin LD. Pediatric Regional Anaesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anaesthesia. Anaesth Analg. 2012 Dec;115(6):1353-64. doi: 10.1213/ANE.0b013e31825d9f4b. Epub 2012 Jun 13. PMID: 22696610.
2. Zadrazil M, Opfermann P, Marhofer P, Westerlund AI, Haider T. Brachial plexus block with ultrasound guidance for upper-limb trauma surgery in children: a retrospective cohort study of 565 cases. Br J Anaesth. 2020 Jul;125(1):104-109. doi: 10.1016/j.bja.2020.03.012. Epub 2020 Apr 24. PMID: 32340734.
3. Merella, F. et al. Ultrasound-guided upper and lower extremity nerve blocks in children. BJA Education, Volume 20, Issue 2, 42 – 50
4. Şengel A, Seçilmiş S. Ultrasound-guided bilateral infraclavicular brachial plexus block: A report of three cases. Saudi J Anaesth. 2022 Apr-Jun;16(2):232-235. doi: 10.4103/sja.sja_737_21. Epub 2022 Mar 17. PMID: 35431733; PMCID: PMC9009546.
5. Mangla C, Kamath HS, Yarmush J. Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures. Local Reg Anaesth. 2019 Sep 27;12:99-102. doi: 10.2147/LRA.S225471. PMID: 31579387; PMCID: PMC6773967.
6. Karim, H.M.R., Panda, C.K., Kumar, M. et al. Perioperative challenges for same sitting bilateral upper limb surgery in a patient of obstructive sleep apnoea, morbid obesity, hypothyroidism, and orthopnea. Ain-Shams J Anaesthesiol 10, 1 (2018). https://doi.org/10.1186/s42077-018-0006-6
7. Renes SH, Spoormans HH, Gielen MJ, Rettig HC, van Geffen GJ. Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block. Reg Anaesth Pain Med. 2009 Nov-Dec;34(6):595-9. doi: 10.1097/aap.0b013e3181bfbd83. PMID: 19916254
8. Holborow J, Hocking G. Regional anaesthesia for bilateral upper limb surgery: a review of challenges and solutions. Anaesth Intensive Care. 2010 Mar;38(2):250-8. doi: 10.1177/0310057X1003800205. PMID: 20369756.
9. Kim BG, Yang C, Lee K, Choi WJ. Bilateral brachial plexus block in a patient with cervical spinal cord injury: A case report. Medicine (Baltimore). 2020 Jul 24;99(30):e21126. doi: 10.1097/MD.0000000000021126. PMID: 32791687; PMCID: PMC7387002.
10. Brand L, Papper EM. A comparison of supraclavicular and axillary techniques for brachial plexus blocks. Anaesthesiology 1961; 22: 226–9.
11. Neuburger M, Landes H, Kaiser H. Pneumothorax bei der vertikalen infraklavikulären Blockade des Plexus brachialis. Fallbericht einer seltenen Komplikation. Anaesthesist 2000; 49: 901–4.
12. Tsui BC, Doyle K, Chu K, Pillay J, Dillane D. Case series: ultrasound-guided supraclavicular block using a curvilinear probe in 104 day-case hand surgery patients. Canadian Journal of Anaesthesia 2009; 56: 46–51.
13. Amiri HR, Espandar R. Upper extremity surgery in younger children under ultrasound-guided supraclavicular brachial plexus block: a case series. J Child Orthop. 2011 Feb;5(1):5-9. doi: 10.1007/s11832-010-0303-5. Epub 2010 Nov 23. PMID: 22295045; PMCID: PMC3024489.
14. Majid Fakhir alhamaidah, Hussain AH, Hussein alkhfaji, Sami RH, Hamza Sh. Abd-Alzahra, Ali B. Roomi: Ultrasound-guided brachial plexus blocks in pediatric anaesthesia: non-systematic review. IOP Conf. Series: Materials Science and Engineering 928 (2020) 062013 IOP Publishing doi:10.1088/1757-899X/928/6/062013
15. Singaravelu Ramesh A, Boretsky K. Local anaesthetic systemic toxicity in children: a review of recent case reports and current literature. Reg Anaesth Pain Med. 2021 Oct;46(10):909-914. doi: 10.1136/rapm-2021-102529. Epub 2021 Jun 7. PMID: 34099573.
16. Goh MS, Bernardo MK, Yuen T, Tsai E and Ovsepian M. Bilateral Brachial Plexus Blocks for Bilateral Upper Extremity Surgery. SM J Anaesth. 2017; 3(2): 1013
17. Al-Talabani BG, Abdullah HO, Kakamad FH, Abdulla BA, Salih KM, Mohammed SH, Salih AM. Bilateral brachial plexus block as alternative to general anaesthesia in high-risk patient; a case report and literature review. Ann Med Surg (Lond). 2022 Feb 11;75:103378. doi:10.1016/j.amsu.2022.103378. PMID: 35242325; PMCID: PMC8881413.
18. Harper G.K., Stafford M.A., Hill D.A. Minimum volume of local anaesthetic required to surround each of the constituent nerves of the axillary brachial plexus, using ultrasound guidance: a pilot study. Br. J. Anaesth. 2010;104(5):633–636.
19. Franco CD, Salahuddin Z, Rafizad A. Bilateral brachial plexus block. Anaesth Analg. 2004 Feb;98(2):518-520. doi: 10.1213/01.ANE.0000097441.67236.33. PMID: 14742397.
20. Graf, Bernhard M. M.D.*; Abraham, Ingo M.D.†; Eberbach, Nicole M.D.†; Kunst, Gudrun M.D.‡; Stowe, David F. M.D., Ph.D.§; Martin, Eike M.D.‖. Differences in Cardiotoxicity of Bupivacaine and Ropivacaine Are the Result of Physicochemical and Stereoselective Properties. The Journal of the American Society of Anaesthesiologists 96(6):p 1427-1434, June 1, 2002. | DOI: 10.1097/00000542-200206000-00023


How to Cite this Article: Srikanth AT, Patil P, Pramod A, V Srikanth | A Case Report on Bilateral Ultrasound Guided Brachial Plexus Block in a Paediatric Patient with Unusual Congenital Anomalies | International Journal of Regional Anaesthesia | July-December 2024; 5(2): 27-30 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.104


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Continuous Erector Spinae Plane Block for Unilateral Multiple Rib Fracture- A Case Report

Vol 5 | Issue 2 | July-December 2024 | Page 23-26 | Navveen PM, Sandeep Diwan

DOI: https://doi.org/10.13107/ijra.2024.v05.i02.102

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted: February 22-11-2024; Reviewed: 28-11-2024; Accepted: 08-12-2024; Published: 10-12-2024


Authors: Navveen PM [1], Sandeep Diwan [2]

[1] AORA Fellow, Sancheti Hospital for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
[2] Department of Anaesthesiology, Sancheti Hospital for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.

Address of Correspondence

Dr. Navveen PM
Department of Anaesthesia, Sancheti Institute of orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Email id: dr.navveen@gmail.com


Abstract

Patients with chest trauma have high morbidity due to rib fractures, lung contusion, hemo/pneumothorax leading to prolonged hospital stay. Adequate pain relief is the key for early recovery following rib fracture. Pain due rib fracture can cause lung atelectasis, flail chest, hypoventilation leading to hypoxia, respiratory failure and further pulmonary complications. Erector spinae plane (ESP) block is an inter-fascial plane block which has been proposed as a regional anaesthesia technique in acute pain management for multiple rib fractures (MRF’s).
Keywords: Multiple rib fracture, Chest trauma, Erector spinae plane block.


References


1. Kuo K, Kim AM. Rib Fracture. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541020/
2. Thoracic Paravertebral Analgesia Through a New Multiple-Hole Catheter- 2016/04/01. doi: 10.1053/j.jvca.2015.09.016. DO – 10.1053/j.jvca.2015.09.016. Journal of Cardiothoracic and Vascular Anesthesia
3. Kumar G, Kumar Bhoi S, Sinha TP, Paul S. Erector spinae plane block for multiple rib fracture done by an Emergency Physician: A case series. Australas J Ultrasound Med. 2020 Aug 30;24(1):58-62. doi: 10.1002/ajum.12225. PMID: 34760612; PMCID: PMC8412024.
4. Diwan S, Garud R, Nair A. Thoracic paravertebral and erector spinae plane block: A cadaveric study demonstrating different site of injections and similar destinations. Saudi J Anaesth. 2019 Oct-Dec;13(4):399-401. doi: 10.4103/sja.SJA_339_19. PMID: 31572102; PMCID: PMC6753759.
5. L May, C Hillermann, S Patil, Rib fracture management, BJA Education, Volume 16, Issue 1, 2016,
6. Diwan, S., Nair, A., Adhye, B. et al. Dual erector spinae plane block for complex traumas of upper and lower limb: an opioid reduction strategy—a case series. Ain-Shams J Anesthesiol 15, 81 (2023). https://doi.org/10.1186/s42077-023-00380-0
7. Diwan, Sandeep; Nair, Abhijit1. Unilateral erector spinae plane block for managing acute pain arising from multiple unilateral injuries: A case report. Indian Journal of Anaesthesia 64(1):p 79-80, January 2020. | DOI: 10.4103/ija.IJA_609_19
8. Periosteal Infusion of Local Anesthetics as an Alternative to Bilateral Subpectoral Interfascial Plane Catheters in Patients with Sternal Fractures, Regional Anesthesia & Pain Medicine. Paul, Barry. 2017/05/01.
9. Rashmi Syal, Sadik Mohammed, Rakesh Kumar, Nidhi Jain, Pradeep Bhatia, Continuous erector spinae plane block for analgesia and better pulmonary functions in patients with multiple rib fractures: a prospective descriptive study, Brazilian Journal of Anesthesiology (English Edition), Volume 74, Issue 1, 2024.


How to Cite this Article: PM Navveen, Diwan S | Continuous Erector Spinae Plane Block for Unilateral Multiple Rib Fracture- A Case Report | International Journal of Regional Anaesthesia | July-December 2024; 5(2):23-26 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.102


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C5 Anomaly and Scalene Muscle Variation- Case Report

Vol 5 | Issue 2 | July-December 2024 | Page 20-22 | Reshma Nath, Sandeep Diwan

DOI: https://doi.org/10.13107/ijra.2024.v05.i02.100

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted: February 19-11-2024; Reviewed: 26-11-2024; Accepted: 05-12-2024; Published: 10-12-2024


Authors: Reshma Nath [1], Sandeep Diwan [2]

[1] AORA Fellow, Sancheti Hospital for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
[2] Department of Anaesthesiology, Sancheti Hospital for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.

Address of Correspondence

Dr. Reshma Nath
Department of Anaesthesiology, Sancheti Hospital for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Email id: resham.vj@gmail.com


Abstract

The brachial plexus is formed by the ventral primary rami of the lower four cervical and upper thoracic nerve roots, with variable contribution from C4 (prefix) & T2 (postfix). Anatomical variations are from the roots to the cord level. A better understanding of such variations is crucial for achieving successful results in regional anaesthesia.
Keywords: Brachial plexus, Anatomical variation, Dual guidance


References


1. Patel NT, Smith HF. Clinically Relevant Anatomical Variations in the Brachial Plexus. Diagnostics (Basel). doi: 10.3390/diagnostics13050830. PMID: 36899974; PMCID: PMC10001373.2023 Feb 22;13(5):830.
2. Han, Yueyin & An, Mingjie & Zilundu, Prince & Zhuang, Zhuokai & Chen, Junyu & Jiang, Zhen & Gu, Liqiang & Yang, Jiantao & Wang, Dong & Xu, Dazheng & Zhou, Li‐Hua. (2024). Anatomical variations of the brachial plexus in adult cadavers: A descriptive study and clinical significance. Microsurgery. 44. 10.1002/micr.31182. https://www.researchgate.net/publication/380924213_Anatomical_variations_of_the_brachial_plexus_in_adult_cadavers_A_descriptive_study_and_clinical_significance
3. ATOTW 369 – Anatomical variation of the brachial plexus and its clinical implications (26th Dec 2017) Page 1-9 https://resources.wfsahq.org/atotw/anatomical-variation-of-the-brachial-plexus-and-its-clinical-implications/
4. Buch – Hansen K. Uber Varietaten des Nervus Musculocutaneous und deren Beziehungen. Anatomischer Anzeiger. 1955; 102:187-203.
5. Developmental anomalies at the thoracic outlet: An analysis of 200 consecutive cases Makhoul, Raymond G. et al.Journal of Vascular Surgery, Volume 16, Issue 4, 534 – 545.


How to Cite this Article: Nath R, Diwan S | C5 Anomaly and Scalene Muscle Variation- Case Report | International Journal of Regional Anaesthesia | July-December 2024; 5(2): 20-22 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.100


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Redefining Limits: Shoulder Disarticulation Under Regional Anaesthesia Alone

Vol 5 | Issue 2 | July-December 2024 | Page 16-19| Vandana Mangal, Momoson Maring Tontanga, Chitra Singh, Tuhin Mistry

DOI: https://doi.org/10.13107/ijra.2024.v05.i02.98

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted: February 18-11-2024; Reviewed: 25-11-2024; Accepted: 02-12-2024; Published: 10-12-2024


Authors: Vandana Mangal [1], Momoson Maring Tontanga [1], Chitra Singh [1], Tuhin Mistry [2]

[1] Department of Anaesthesiology and Critical Care, SMS Medical College, Jaipur, Rajasthan, India.
[2] Department of Anaesthesiology and Perioperative Care, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India

Address of Correspondence

Dr. Tontanga Momoson Maring
Department of Anaesthesiology and Critical Care, SMS Medical College, Jaipur, Rajasthan, India.
Email id: drmomoson@gmail.com


Abstract

Shoulder disarticulation following of animal bites is not uncommon and is often performed for various indications, including vascular insufficiency. General anaesthesia is usually the preferred choice in optimized patients, with or without regional anaesthesia. Phantom limb pain is a distressing and frequently encountered condition following limb amputation. In addition to their well-established benefits, nerve blocks not only provide effective perioperative analgesia but may also reduce the incidence of phantom limb pain. In this case, we undertook shoulder disarticulation exclusively under regional anaesthesia, as the patient’s respiratory condition was not optimal for general anaesthesia.

Keywords: Shoulder disarticulation, Regional anaesthesia, Subclavian perivascular block, Superficial cervical plexus block, Pectoserratus plane block.


References


1. Mahajan, A., Luther, A., & Chhabra, A. (2015). Brachial artery injury caused by camel bite. Indian Journal of Vascular and Endovascular Surgery, 2(1), 33. https://doi.org/10.4103/0972-0820.152834
2. Abu-Zidan FM, Hefny AF, Eid HO, Bashir MO, Branicki FJ. Camel-related injuries: Prospective study of 212 patients World J Surg. 2012;36:2384–9
3. Maduri P, Akhondi H. Upper Limb Amputation. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK540962/
4. Donnelly, M. R., & Hacquebord, J. H. (2023). Shoulder level amputation: Forequarter and brachial plexus-level amputation. Operative Techniques in Orthopaedics, 33(3), 101056. https://doi.org/10.1016/j.oto.2023.101056
5. Kilicaslan A, Gok F, Colak TS, Keklicek O, Kucuksen MF. Combined interscalene, superficial cervical plexus and thoracic intertransverse process blocks for surgical anaesthesia of the shoulder disarticulation. Anaesth Rep. 2024;12(1):e12306. Published 2024 May 29. doi:10.1002/anr3.12306
6. Mbabazi P, Mwaniki M, Wambua G, Kagua S, Kamau RW, Daggett J, Nthumba PM. Successful Shoulder Disarticulation under Local Anesthesia in the COVID-19 Era. Plast Reconstr Surg Glob Open. 2023 Sep 13;11(9):e5266. doi: 10.1097/GOX.0000000000005266. PMID: 37711723; PMCID: PMC10499080.
7. Duggappa DR, Rao GV, Kannan S. Anaesthesia for patient with chronic obstructive pulmonary disease. Indian J Anaesth. 2015 Sep;59(9):574-83. doi: 10.4103/0019-5049.165859. PMID: 26556916; PMCID: PMC4613404.
8. Miniato MA, Anand P, Varacallo MA. Anatomy, Shoulder and Upper Limb, Shoulder. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536933/
9. Hamadnalla, H., Elsharkawy, H., Shimada, T. et al. Cervical erector spinae plane block catheter for shoulder disarticulation surgery. Can J Anesth/J Can Anesth 66, 1129–1131 (2019). https://doi.org/10.1007/s12630-019-01421-9
10. Mbabazi P, Mwaniki M, Wambua G, Kagua S, Kamau RW, Daggett J, Nthumba PM. Successful Shoulder Disarticulation under Local Anesthesia in the COVID-19 Era. Plast Reconstr Surg Glob Open. 2023 Sep 13;11(9):e5266. doi: 10.1097/GOX.0000000000005266. PMID: 37711723; PMCID: PMC10499080.


How to Cite this Article: Mangal V, Tontanga MM, Singh C, Mistry T | Redefining Limits: Shoulder Disarticulation Under Regional Anaesthesia Alone | International Journal of Regional Anaesthesia | July-December 2024; 5(2): 16-19 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.98


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Brachial Plexus Block above the level of clavicle in Multi-Comorbid Patients with Difficult Surface Landmarks and Cervical Ankylosing Spondylosis

Vol 5 | Issue 2 | July-December 2024 | Page 10-12| Nitin Gawai, Sandeep Diwan, Ganesh Bhong, Sunil Dixit, Parag Sancheti

DOI: https://doi.org/10.13107/ijra.2024.v05.i02.94

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted: February 18-07-2024; Reviewed: 12-09-2024; Accepted: 14-10-2024; Published: 10-12-2024


Authors: Nitin Gawai [1], Sandeep Diwan [1], Ganesh Bhong [2], Sunil Dixit [1], Parag Sancheti [3]

[1] Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra, India.
[2] Anesthesiology Consultant, Pune, Maharashtra, India.
[3] Department of Orthopaedics, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence

Dr. Nitin Gawai,
Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra, India.
E-mail: drnitingawai@yahoo.com


Abstract

Blocks above the clavicle [BAC- interscalene and supraclavicular] are routinely performed with surface anatomical landmark, and recently with ultrasound. Landmark techniques involving mid-point of clavicle is routinely used. However, with abnormal topography of the clavicle anatomy, the landmarks are distorted. Both, neurostimulation and ultrasound face stiff challenges in patients with abnormal clavicle anatomy. In four patients, with abnormal clavicle, BAC was attempted for surgical corrections of proximal and shaft of humerus. Though landmark and ultrasound guided blocks were successful, we reveal the importance of alternative landmarks and possible complications that might may be associated with abnormal anatomical landmarks.
Keywords: Brachial Plexus Block, Multi-Comorbid Patients, Difficult Surface Landmarks, Cervical Ankylosing Spondylosis


References


1. Katherine M. Shaffer Spread of local anesthetic during an ultrasound-guided interscalene block: does the injection site influence diffusion? Acta Anaesthesiol Scand 2011; 55: 664–669.
2. Franco CD: The subclavian perivascular block. Tech Reg Anesth Pain Manage 1999;3: 212–216.
3. Haleem, Shahla; Siddiqui, Ahsan K.; Mowafi, Hany A. Nerve Stimulator Evoked Motor Response Predicting a Successful Supraclavicular Brachial Plexus Block; More Anesthesia & Analgesia. 110(6):1745-1746, June 2010.
4. Dupre, L.-J., Danel. V., Legrand, J.-J., and Stieglitz, P.: Surface landmarks for supraclavicular block of the brachial plexus. Anesth Analg 1982; 61:28-31.
5. Anand M. Sardesai, Roger Patel, Nicholas M. Denny, David K. Menon, Adrian K. Dixon, Martin J. Herrick, Alan W. Harrop-Griffiths; Interscalene Brachial Plexus Block: Can the Risk of Entering the Spinal Canal Be Reduced? A Study of Needle Angles in Volunteers Undergoing Magnetic Resonance Imaging. Anesthesiology 2006; 105:9–13.
6. Albrecht, J. Mermoud, N. Fournier, C. Kern and K. R. Kirkham A systematic review of ultrasound-guided methods for brachial plexus blockade Anaesthesia 2016, 71, 213–227.
7. Gautier P, Vandepitte C, Ramquet C, DeCoopman M, Xu D, Hadzic A. The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg. 2011 Oct;113(4):951-5.
8. Gregg A. Korbon, Harold Carron and Christopher J. Lander, First Rib Palpation: A Safer, Easier Technique for Supraclavicular Brachial Plexus Block ANESTH ANALG 1989;68:682-5.
9. Duggan E, El Beheiry H, Perlas A, Lupu M, Nuica A, Chan VW, Brull R. Minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009 May-Jun;34(3):215-8.
10. Pavičić Šarić J, Vidjak V, Tomulić K, Zenko J. Effects of age on minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block. Acta Anaesthesiol Scand. 2013 Jul;57(6):761-6.
11. Verelst P, van Zundert A. Respiratory impact of analgesic strategies for shoulder surgery. Reg Anesth Pain Med. 2013 Jan-Feb;38(1):50-3. doi: 10.1097/AAP.0b013e318272195d. PMID: 23132510. 12.
12. Plante T, Rontes O, Bloc S, Delbos A. Spread of local anesthetic during an ultrasound-guided interscalene block: does the injection site influence diffusion? Acta Anaesthesiol Scand. 2011 Jul;55(6):664-9.


How to Cite this Article: Gawai N, Diwan S, Bhong G, Dixit S, Sancheti P | Brachial Plexus Block above the level of clavicle in Multi-Comorbid Patients with Difficult Surface Landmarks and Cervical Ankylosing Spondylosis | International Journal of Regional Anaesthesia | July-December 2024; 5(2): 10-12 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.94


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Comparison of the Efficacy of Intravenous and Regional Dexamethasone in Brachial Plexus Nerve Block

Vol 5 | Issue 2 | July-December 2024 | Page 4-9| Sushmitha K, Shripad Mahadik, Deepak Phalgune, Sandeep Mutha, Sudhir Patil

DOI: https://doi.org/10.13107/ijra.2024.v05.i02.92

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted: February 27-10-2024; Reviewed: 10-11-2024; Accepted: 18-11-2024; Published: 10-12-2024


Authors: Sushmitha K [1], Shripad Mahadik [1], Deepak Phalgune [2], Sandeep Mutha [1], Sudhir Patil [1]

[1] Department of Anaesthesiology, Poona Hospital & Research Centre, Pune, Maharashtra, India.
[2] Department of Research, Poona Hospital & Research Centre, Pune, Maharashtra, India.

Address of Correspondence

Dr. Deepak Phalgune,
Department of Research, Poona Hospital & Research Centre, Pune, Maharashtra, India.
E-mail: dphalgune@gmail.com


Abstract

The brachial plexus nerve block (BPNB) is a widely employed regional nerve block of the upper extremity. Some trials report longer duration of analgesia with perineural compared to intravenous (IV) dexamethasone, other studies have failed to detect significant differences between the two modalities in BPNB. The present study aims to compare the efficacy of IV and perineural dexamethasone as an adjuvant in BPNB. One hundred ten patients aged between 18 and 60 years, scheduled to undergo upper limb surgery under BPNB were randomly divided into two groups by computer-generated table. Group A patients received IV dexamethasone 8 mg immediately after receiving BPNB with adrenalized lignocaine and bupivacaine. Group B patients received dexamethasone 8 mg along with adrenalized lignocaine and bupivacaine perineurally. The onset time of the sensory block (OTSB), the time for the complete sensory block (TCSB), the onset time of the motor block (OTMB), the time for the complete motor block (TCMB), and the period of sensory and motor blockade were recorded. The visual analogue scale (VAS) score was noted. The mean OTSB, TCSB, OTMB, and TCMB were significantly higher in Group A than in Group B, whereas the mean duration of sensory and motor blockade was significantly higher in Group B than in Group A. The mean VAS score at 16 and 24 hours postoperatively was significantly higher in Group A than in Group B. The efficacy of dexamethasone along with local anaesthetic perineurally was higher than IV dexamethasone in BPNB.
Keywords: Dexamethasone, intravenous, Motor block, Perineural, Sensory block


References


1) Brown DL, Birdenbaugh DL, Cousins MJ, Bridenburgh PO. The upper extremity. 3rd ed. Chapter 10. In: Neural blockade; 1998. pp.345-6.
2) Pathak RG, Satkar AP, Khade RN. Supraclavicular brachial plexus block with and without dexamethasone–a comparative study. Int J Sci Res Pub. 2012;2(12):1-7.
3) Chang A, Dua A, Singh K, White BA. Peripheral Nerve Blocks. [Updated 2023 Jul 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459210/
4) Zhao WL, Ou XF, Liu J, Zhang WS. Perineural versus intravenous dexamethasone as an adjuvant in regional anesthesia: a systematic review and meta-analysis. J Pain Res. 2017; 10:1529-43.
5) Chong MA, Berbenetz NM, Lin C, Singh S. Perineural versus intravenous dexamethasone as an adjuvant for peripheral nerve blocks: a systematic review and meta-analysis. Reg Anesth Pain Med. 2017;42(3):319-26.
6) Kirkham KR, Jacot-Guillarmod A, Albrecht E. Optimal dose of perineural dexamethasone to prolong analgesia after brachial plexus blockade: a systematic review and meta-analysis. Anesth Analg. 2018; 126(1):270-9.
7) Kawanishi R, Yamamoto K, Tobetto Y, Nomura K, Kato M, Go R, et al. Perineural but not systemic low-dose dexamethasone prolongs the duration of interscalene block with ropivacaine: a prospective randomized trial. Local Reg Anesth. 2014 ;7:5-9.
8) Abdallah FW, Johnson J, Chan V, et al. Intravenous dexamethasone and perineural dexamethasone similarly prolong the duration of analgesia after supraclavicular brachial plexus block. Reg Anesth Pain Med. 2015;40:125–132
9) Desmet M, Braems H, Reynvoet M, et al. I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized, placebo-controlled study. Br J Anaesth. 2013; 111:445–452
10) Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg. 2006; 102:263–7
11) De Oliveira GS Jr, Almeida MD, Benzon HT, McCarthy RJ. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2011;115(3):575-88.
12) Leurcharusmee P, Aliste J, Van Zundert TC, Engsusophon P, Arnuntasupakul V, Tiyaprasertkul W, et al. A Multicenter Randomized Comparison Between Intravenous and Perineural Dexamethasone for Ultrasound-Guided Infraclavicular Block. Reg Anesth Pain Med. 2016 ;41(3):328-33.
13) Harvey Motulsky. Intuitive Biostatistics. New York: Oxford University Press; 1995.
14) Wedel DJ, HorlockerTT. Nerve Blocks. In: Miller RD. Editor Miller’s Anesthesia: 7th ed. Philadelphia: Churchill Livingstone;2010. p.1639-74.
15) Bei T, Liu J, Huang Q, Wu J, Zhao J. Perineural Versus Intravenous Dexamethasone for Brachial Plexus Block: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Pain Physician. 2021;24(6): E693-707.
16) Kelly AM. Does the clinically significant difference in visual analogue scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med. 1998; 5(11):1086-90.
17) Héroux J, Bessette PO, Belley-Côté E, Lamarche D, Échavé P, Loignon MJ, et al. Functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery: a systematic review. BMC Anesthesiol. 2023;23(1):91
18) Abrahams MS, Aziz MF, Fu RF, Horn JL. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2009;102(3):408-17
19) Swain A, Nag DS, Sahu S, Samaddar DP. Adjuvants to local anesthetics: Current understanding and future trends. World J Clin Cases. 2017;5(8):307-23
20) Mathew R, Radha KR, Hema VR. Effect of perineural and intravenous dexamethasone on duration of analgesia in supraclavicular brachial plexus block with bupivacaine: a comparative study. Anesth Essays Res. 2019;13(2):280-3.
21) Sakae TM, Marchioro P, Schuelter-Trevisol F, Trevisol DJ. Dexamethasone as a ropivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: a randomized, double-blinded clinical trial. J Clin Anesth. 2017; 38:133-6.
22) Rosenfeld DM, Ivancic MG, Hattrup SJ, Renfree KJ, Watkins AR, Hentz JG, et al. Perineural versus intravenous dexamethasone as adjuncts to local anaesthetic brachial plexus block for shoulder surgery. Anaesthesia. 2016;71(4):380-8.
23) Holland D, Amadeo RJJ, Wolfe S, Girling L, Funk F, Collister M, et al. Effect of dexamethasone dose and route on the duration of interscalene brachial plexus block for outpatient arthroscopic shoulder surgery: a randomized controlled trial. Can J Anesth. 2018; 65(1):34-45.
24) Tan ESJ, Tan YR, Liu CWY. Efficacy of perineural versus intravenous dexamethasone in prolonging the duration of analgesia when administered with peripheral nerve blocks: a systematic review and meta-analysis. Korean J Anesthesiol 2022;75(3):255-65


How to Cite this Article: Sushmitha K, Mahadik S, Phalgune D, Mutha S, Patil S | Comparison of the Efficacy of Intravenous and Regional Dexamethasone in Brachial Plexus Nerve Block | International Journal of Regional Anaesthesia | July-December 2024; 5(2): 4-9 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.92


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Rebound Pain After Nerve Block- Is it Inevitable, or Can it be Tackled?

Vol 5 | Issue 2 | July-December 2024 | Page 1-3| Abhijit S. Nair

DOI: https://doi.org/10.13107/ijra.2024.v05.i02.90

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted: 15/10/2024; Reviewed: 24/10/2024; Accepted: 12/11/2024; Published: 10/12/2024


Authors: Abhijit S. Nair [1]

[1] Department of Anaesthesiology, Ibra Hospital, Sultanate of Oman.

Address of Correspondence

Dr. Abhijit S. Nair,
Department of Anaesthesiology, Ibra Hospital, Sultanate of Oman.
Email: abhijitnair95@gmail.com


Editorial

Postoperative rebound pain occurs when patients experience a marked increase in pain intensity after the effects of a peripheral nerve block (PNB) wear off. In addition to long-term problems like chronic postoperative pain, opioid use disorder, and higher medical expenses, poorly managed postoperative pain may contribute to respiratory and cardiovascular adverse events.
PNBs and other regional anaesthesia techniques, like the fascial plane blocks, are frequently used to offer superior intraoperative and early postoperative analgesia. In addition to revolutionizing postoperative pain management, the use of PNBs as part of an anaesthetic and analgesic strategy has been associated with a decrease in patient exposure to opioids and their adverse effects. However, after the sensory block is resolved, a clinical phenomenon known as “rebound pain” (RP) can arise [1]. This is characterized by an abrupt, frequently severe resurgence of pain. Optimizing patient outcomes requires proactive management and awareness of RP.
Patients undergoing orthopaedic surgeries have a greater propensity to encounter RP than patients undergoing soft tissue surgery [2]. RP presents as a state of hyperalgesia with an onset between 8 and 24 h after block administration, depending on the block characteristics (volume, concentration, and success). The various consequences of rebound pain are patient dissatisfaction, functional impairment, increased opioid consumption, and increased healthcare utilisation.
Based on a retrospective study published by Williams et al, they mentioned that RP is the ‘quantifiable difference in pain scores when the block is working versus the increase in acute pain encountered during the first few hours after the effects of peri-neural single-injection or continuous infusion local anaesthetics resolve’ [3]. Dada et al. published a narrative review that investigated whether rebound pain had any influence on postoperative analgesia and opioid consumption [4]. In this paper, they defined RP as a state of hyperalgesia with an onset between 8 and 24 h after block administration. Lavand’homme defined RP as a very severe pain when PNB wears off, which is a clinically relevant problem and a cause of increased healthcare resource utilization after ambulatory surgery [5].
Sunderland et al compared the incidence of severe postoperative pain in patients undergoing wrist fracture surgery under general anaesthesia with brachial plexus block versus general anaesthesia only [6]. They found that the incidence of postoperative pain was 40% in the block group versus 10% in the no block group. The authors emphasized using adjuvants in the blocks, prescribing multimodal analgesia, and educating patients on using regular analgesics, and also the possibility of rebound pain if the advice on analgesic use is not adhered to.
The pathophysiology of RP is not fully understood. It is considered a multifactorial entity. Increased nociceptors’ excitability and the spontaneous hyperactivity of C-fibers may be contributing factors to neuropathic pain. Even after the PNB obtunds the transduction and conduction, the surgical stimulus nevertheless produces pain signals. This results in central sensitization that causes hyperalgesia and allodynia [8]. Pain becomes more severe as the effects of PNB wear off, leading to excruciating pain. One more contributing factor is the reversible neurotoxicity of local anaesthetics (LA) [8]. RP may also be a side effect of injury to nerves from intra-fascicular injections and extended tourniquet use. The list of adjuvants that can be used in PNBs includes several medications like clonidine, dexmedetomidine, dexamethasone, buprenorphine, midazolam, epinephrine, ketamine, tramadol, magnesium, morphine, nalbuphine, sodium bicarbonate, and sodium bicarbonate. These adjuvants help in prolonging the duration of PNBs, provide better satisfaction, reduce opioid consumption and adverse events like nausea/vomiting, and possibly early recovery. However, there is a concern about the neurotoxicity of most of these adjuvants used in PNB [9-12].
Perineural dexamethasone is probably the most commonly used adjuvant in PNB. However, several studies and review articles have concluded that both perineural and intravenous dexamethasone can reduce rebound pain after a PNB performed for perioperative analgesia [13,14]. Perineural ketamine in varying doses has been found quite effective in prolonging analgesia and reducing rebound pain in several studies [15]. Based on the results of a systematic review and meta-analysis involving 20 randomised-controlled trials, Xiang et al concluded that perineural ketamine could be an ideal adjuvant to local anaesthetics irrespective of the types of anaesthesia employed [16]. However, the quality of the evidence was low. A similar efficacy in reducing rebound pain was not demonstrated when ketamine was used intravenously [17,18]. Theoretically, liposomal local anaesthetics could prolong the duration of analgesia when used in a PNB. However, the current evidence is insufficient to support its use to prevent RP, as the level of evidence is moderate [19].
Another modality of reducing rebound pain following a PNB is using continuous analgesia with indwelling catheters. The issue with this modality is the catheter migration or dislodgement, the additional cost incurred, and the expertise needed to effectively secure or tunnel the catheters at the desired site [20].
Factors responsible for rebound pain could be patient-related, surgical, or regional anaesthesia technique-related. In the patient’s category, the younger age group patients undergoing surgery, patients having preoperative pain (trauma, periarthritis) are the ones susceptible to RP. In the surgical category, orthopaedic surgery could predispose to RP. In the regional anaesthesia category, use of PNB that leads to dense sensory block (brachial plexus block, popliteal sciatic block, lumbosacral block) has a higher propensity of RP than fascial plane blocks.
Pre-emptive analgesia before the block wearing off, intra-articular or intravenous anti-inflammatory drugs like dexamethasone, use of catheters for continuous analgesia, and the use of adjuvants in nerve blocks along with use of other analgesics like acetaminophen, non-steroidal anti-inflammatory drugs, if not contraindicated, are examples of multimodal strategies that could mitigate the severity of RP. Furthermore, it is crucial to inform patients about the potential for RP to guarantee the proper administration of pre-emptive analgesic prescriptions and set realistic expectations for reduced postoperative opioid requirements. To effectively use regional anaesthesia and lessen the negative effects of chronic opioid use, it is essential to understand the effects of RP and measures to avoid them.


References


1. Murphy KJ, O’Donnell B. Rebound Pain-Management Strategies for Transitional Analgesia: A Narrative Review. J Clin Med. 2025 Jan 31;14(3):936.
2. Barry GS, Bailey JG, Sardinha J, Brousseau P, Uppal V. Factors associated with rebound pain after peripheral nerve block for ambulatory surgery. Br J Anaesth. 2021; 126:862-71.
3. Williams BA, Bottegal MT, Kentor ML, Irrgang JJ, Williams JP. Rebound pain scores as a function of femoral nerve block duration after anterior cruciate ligament reconstruction: Retrospective analysis of a prospective, randomized clinical trial. Reg Anesth Pain Med. 2007; 32: 186–192.
4. Dada O, Gonzalez Zacarias A, Ongaigui C, Echeverria-Villalobos M, Kushelev M, Bergese SD, Moran K. Does Rebound Pain after Peripheral Nerve Block for Orthopedic Surgery Impact Postoperative Analgesia and Opioid Consumption? A Narrative Review. Int J Environ Res Public Health. 2019 Sep 5;16(18):3257.
5. Lavand’homme P. Rebound pain after regional anesthesia in the ambulatory patient. Curr Opin Anaesthesiol. 2018 Dec;31(6):679-684.
6. Sunderland S, Yarnold CH, Head SJ, Osborn JA, Purssell A, Peel JK, Schwarz SKW. Regional Versus General Anesthesia and the Incidence of Unplanned Health Care Resource Utilization for Postoperative Pain After Wrist Fracture Surgery: Results from a Retrospective Quality Improvement Project. Reg Anesth Pain Med. 2016;41: 22.
7. Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009 Sep;10(9):895-926.
8. Verlinde M, Hollmann MW, Stevens MF, Hermanns H, Werdehausen R, Lirk P. Local Anesthetic-Induced Neurotoxicity. Int J Mol Sci. 2016 Mar 4;17(3):339.
9. Swain A, Nag DS, Sahu S, Samaddar DP. Adjuvants to local anesthetics: Current understanding and future trends. World J Clin Cases. 2017 Aug 16;5(8):307-323.
10. Jeon YH. The use of adjuvants to local anesthetics: benefit and risk. Korean J Pain. 2018 Oct;31(4):233-234.
11. Prabhakar A, Lambert T, Kaye RJ, Gaignard SM, Ragusa J, Wheat S, Moll V, Cornett EM, Urman RD, Kaye AD. Adjuvants in clinical regional anesthesia practice: A comprehensive review. Best Pract Res Clin Anaesthesiol. 2019 Dec;33(4):415-423.
12. Krishna Prasad GV, Khanna S, Jaishree SV. Review of adjuvants to local anesthetics in peripheral nerve blocks: Current and future trends. Saudi J Anaesth. 2020 Jan-Mar;14(1):77-84.
13. Singh NP, Makkar JK, Chawla JK, Sondekoppam RV, Singh PM. Prophylactic dexamethasone for rebound pain after peripheral nerve block in adult surgical patients: systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials. Br J Anaesth. 2024 May;132(5):1112-1121.
14. Li Q, Nie H, Wang Z, Li S, Wang Y, Chen N, Wang W, Xu F, Zhang D. The Effects of Perineural Dexamethasone on Rebound Pain After Nerve Block in Patients With Unicompartmental Knee Arthroplasty: A Randomized Controlled Trial. Clin J Pain. 2024 Jul 1;40(7):409-414.
15. Zhu T, Gao Y, Xu X, Fu S, Lin W, Sun J. Effect of Ketamine Added to Ropivacaine in Nerve Block for Postoperative Pain Management in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Randomized Trial. Clin Ther. 2020 May;42(5):882-891.
16. Xiang J, Cao C, Chen J, Kong F, Nian S, Li Z, Li N. Efficacy and safety of ketamine as an adjuvant to regional anesthesia: A systematic review and meta-analysis of randomized controlled trials. J Clin Anesth. 2024 Jun; 94:111415.
17. Touil N, Pavlopoulou A, Barbier O, Libouton X, Lavand’homme P. Evaluation of intraoperative ketamine on the prevention of severe rebound pain upon cessation of peripheral nerve block: a prospective randomised, double-blind, placebo-controlled study. Br J Anaesth. 2022 Apr;128(4):734-741.
18. Joseph C, Gaillat F, Duponq R, Lieven R, Baumstarck K, Thomas P, Penot-Ragon C, Kerbaul F. Is there any benefit to adding intravenous ketamine to patient-controlled epidural analgesia after thoracic surgery? A randomized double-blind study. Eur J Cardiothorac Surg. 2012 Oct;42(4):e58-65.
19. Nguyen A, Grape S, Gobbetti M, Albrecht E. The postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve and field blocks: A systematic review and meta-analysis, with trial sequential analysis. Eur J Anaesthesiol. 2023 Sep 1;40(9):624-635.
20. Ilfeld BM. Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities. Anesth Analg. 2017 Jan;124(1):308-335.


How to Cite this Article: Nair A | Rebound Pain After Nerve Block- Is it Inevitable, or Can it be Tackled? | International Journal of Regional Anaesthesia | July-December 2024; 5(2): 01-03 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.90


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Organizing an AORA Conference: Both Inspiring and Challenging!

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?

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


1. Han JR, Tran J, Agur AM. Overview of the Innervation of Ankle Joint. (1) Rangappa P. History of analgesia and regional anaesthesia through philately. Anaesthesia and intensive care. 2008 Jul;36(1_suppl):12-8.
(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.
(3) https://www.nmc.org.in/wp-content/uploads/2019/09/MD-Anesthesia.pdf
(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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