“Coming Together is a Beginning; Keeping Together is Progress; Working Together is Success”……Henry Ford

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Vol 2 | Issue 1 | January-June 2021 | Page 01 | Vrushali Ponde

DOI: 10.13107/ijra.2021.v02i01.015

Authors: Vrushali Ponde [1]

[1] National President and Ex founder secretary Academy of Regional Anaesthesia, India.

Address of Correspondence

Dr. Vrushali Ponde,
National President and Ex founder secretary
Academy of Regional Anaesthesia, India.
E-mail: vrushaliponde@gmail.com

“Team AORA” has come a long way in learning, teaching and researching and innovating regional anaesthesia. From hands-on workshops to full-fledge post-doctoral fellowships of a year’s duration looks like a joyous journey done together.
As I write this, the enthusiasm towards honing skills in regional anaesthesia, RA, is palpable. Even in the most trying times of the current pandemic scenario’s, RA stood to its promise of safety. Not just towards the patients, on this occasion, the safety of the personal in the operation theatres too. Such is the scope and play of this subject.
I take this opportunity to present to you the various protocols and simple practical clinical pearls charted out by the AORA committee of protocols and guidelines. These are done considering the uniqueness of Indian work culture and practices. This can be looked into as a bridge between the most ideal and yet practically implementable work patterns. (Annexure 1, 2 and 3)
I submit my heartfelt thanks to our editor in chief, Dr Sandeep Diwan, to have taken the initiative of embarking on and continuing with the International Journal of Regional Anaesthesia, the official publication of AORA, India.

How to Cite this Article: Ponde V | Coming Together is a Beginning; Keeping Together is Progress; Working Together is Success”……Henry Ford | International Journal of Regional Anaesthesia | January-April 2021; 2(1): 01.

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Sterility Protocols During Regional Anaesthesia: An AORA Initiative

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Vol 2 | Issue 1 | January-June 2021 | Page 05-12 | Rammurthy Kulkarni, Amjad Maniar, Neha Singh, Vrushali Ponde, Kapil Gupta, Mohammad Azam Danish, Ritesh Roy, Archana Areti

Authors: Rammurthy Kulkarni [1], Amjad Maniar [1], Neha Singh [6], Vrushali Ponde [4], Kapil Gupta [3], Mohammad Azam Danish [5], Ritesh Roy [2], Archana Areti [7]

[1] Department of Anaesthesia, Axon Anaesthesia Associates, Bengaluru, Karnataka, India.
[2] Department of Anaesthesia, AIIMS, Bhubhaneshwar, Odisha, India.
[3] Director Child Anaesthesia Services, Mumbai, Maharashtra, India.
[4] Department of Anaesthesia, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.
[5] Department of Anaesthesia, B. M. Jain Hospital, Bengaluru, Karnataka, India.
[6] Associate Clinical Director and HOD, Care Hospitals, Bhubaneshwar, Odisha, India.
[7] Department of Anaesthesia, Mahatma Gandhi Medical College Research Institute Puducherry, India.

Address of Correspondence
Dr. Vrushali Ponde, Director Child Anaesthesia Services, Mumbai, Maharashtra, India.
E-mail: vrushaliponde@gmail.com

Introduction

The frequency of infection following peripheral nerve block (PNB) is not very clear. The major reason for the paucity of literature is under-reporting of infectious complications. Though rare, the infectious complications associated with peripheral nerve blocks can be devastating and occasionally fatal.1 One case of necrotising fasciitis following an axillary approach to brachial plexus blockade for carpal tunnel release has been reported where the PNB was directly attributed to the infection. With the increase in the number of peripheral nerve block procedures being performed (both single injection and continuous techniques), it is expected that the infectious complication rate may also increase.
There is no uniform consensus amongst anaesthesiologists across the globe regarding the appropriate sterile technique that should be practised during the administration of regional anaesthesia. In a UK and Ireland based survey of obstetric anaesthesiologists, only half of the responders wore a face mask for both neuraxial (spinal and epidural) techniques. One-third of those who did not wear a mask believed that the mask actually increased the risk of infection.2 It can be easily assumed that a similar attitude is present while performing PNBs.
The aseptic chain starts right from hand washing and ends after the block needle has been taken out from the patient’s body (in a single injection technique) or till the perineural catheter is completely removed (in a continuous technique). Any breach in this chain may increase the chances of introducing infection.

References

1. Nseir S, Pronnier P, Soubrier S, Onimus T, Saulnier F, Mathieu D, Duroche A. Fatal streptococcal necrotizing fasciitis as a complication of axillary brachial plexus block. Br J Anaesth 2004; 92: 427-9.
2. Panikkar KK, Yentis SM. Wearing of masks for obstetric regional anaesthesia. Anaesthesia. 1996; 51: 398-400.
3. Hebl JR. The Importance and Implications of Aseptic Techniques During Regional Anesthesia. Reg Anesth Pain Med. 2006; 31(4):311-323.
4. Sellors JE, Cyna AM, Simmons SW. Aseptic precautions for inserting an epidural catheter: A survey of obstetric anaesthetists. Anaesthesia. 2002; 57:593-596.
5. Hartley JC, Mackay AD, Scott GM. Wrist watches must be removed before washing hands.BMJ. 1999; 318 (30): 328.
6. Jumaa PA. Hand hygiene: simple and complex. International Journal of Infectious Diseases.2005; 9: 3-14.
7. Mulroy MF, Weller RS, MD, Liguori GA. A Checklist for Performing Regional Nerve Blocks. Reg Anesth Pain Med. 2014; 39 (3): 195-199.
8. World Health Organization. WHO guidelines on hand hygiene in health care, 2009. Available from: http://whqlibdoc.who.int/publications/2009/ 9789241597906_eng.pdf. Accessed September 19, 2012.
9. Sahni N, Biswal M, Gandhi K, Yaddanapudi S. Quantification of hand hygiene compliance in anesthesia providers at a tertiary care center in northern India. American Journal of Infection Control. 2015; 43(10): 1134-1136.
10. Munoz-Price LS, Bowdle A, Johnston BL, Bearman G, Camins BC, Dellinger EP, et al. Infection prevention in the operating room anesthesia work area. Infection Control & Hospital Epidemiology. 2019. 1–17.
11. Capdevila X, Bringuier S, Borgeat A. Infectious risk of continuous peripheral nerve blocks. Anesthesiology.2009; 110 (1): 182-188.
12. Lee JJ, Parry H. Bacterial meningitis following spinal anaesthesia for Caesarean section. British Journal of Anaesthesia. 1991; 66: 383-386.
13. Schneeberger PM, Janssen M, Voss A. Alpha-hemolytic streptococci: A major pathogen of iatrogenic meningitis following lumbar puncture. Case reports and a review of the literature. Infection. 1996; 24:29-33.
14. Moen V. Meningitis is a rare complication of spinal anesthesia. Good hygiene and face masks are simple preventive measures. Lakartidningen. 1998; 95(7):628, 631-2, 635.
15. Wildsmith JA. Regional anaesthesia requires attention to detail. Br J Anaesth. 1991; 67:224-225.
16. Philips BJ, Fergusson S, Armstrong P, Anderson FM, Wildsmith JA. Surgical face masks are effective in reducing bacterial contamination caused by dispersal from the upper airway. Br J Anaesth. 1992; 69(4): 407-8.
17. Rope T, Thunga S, Plaat F. Should unmasked anaesthetists be given benefit of the doubt? Anaesthesia. 2008; 63: 1372–1386.
18. Schweizer RT. Mask wiggling as a potential cause of wound contamination. Lancet 1976; 2:1129-1130.
19. Orr NW. Is a mask necessary in the operating theatre? Ann R Coll Surg Engl. 1981; 63: 390.
20. Black SR, Weinstein RA. The Case for Face Masks—Zorro or Zero? Clinical Infectious Diseases. 2000; 31:522–3.
21. Skinner MW, Sutton BA. Do Anaesthetists Need to Wear Surgical Masks in the Operating Theatre? A Literature Review with Evidence Based Recommendations. Anaesth Intensive Care. 2001; 29: 331-338.
22. Gharabawy R, Abd-Elsayed A, Elsharkawy H, Farag E, Cummings K, Eid G et al. The Cleveland Clinic Experience with Supraclavicular and Popliteal Ambulatory Nerve Catheters. Scientific World Journal.2014. Article ID 572507, 9pages.
23. Borgeat A, Blumenthal S, Lambert M, Theodorou P, Vienne P. The Feasibility and Complications of the Continuous Popliteal Nerve Block: A 1001- Case Survey. Anesth Analg. 2006; 103:229–33.
24. Compère V, Rey N, Baert O, Ouennich A, Fourdrinier V, Roussignol X, Beccari R, Dureuil B. Major complications after 400 continuous popliteal sciatic nerve blocks for post-operative analgesia. Acta Anaesthesiol Scand. 2009; 53: 339–345.
25. Neuburger M, Breitbarth J, Reisig F, Lang D, Büttner J. Complications and adverse events in continuous peripheral regional anesthesia. Results of investigations on 3,491 catheters. Anaesthesist. 2006; 55:33–40.
26. Neuburger M, Büttner J , Blumenthal S, Breitbarth J, Borgeat A. Inflammation and infection complications of 2285 perineural catheters: a prospective study Acta Anaesthesiol Scand. 2007; 51:108–114.
27. Capdevila X, Bringuier S, Borgeat A. Infectious risk of continuous peripheral nerve blocks. Anesthesiology. 2009; 110(1):182-188.
28. Reisig1 F, Neuburger M, Zausig YA, Graf BM, Büttner J. Successful infection control in regional anesthesia procedures. Observational survey after introduction of the DGAI hygiene recommendations. Anaesthesist. 2013; 62:105–112.
29. Aveline C, Hetet HL, Roux AL, Vautier P, Gautier JF, Fabrice Cognet et al. Perineural Ultrasound-Guided Catheter Bacterial Colonization: A Prospective Evaluation in 747 Cases. Reg Anesth Pain Med. 2011; 36: 579-584.
30. Bergman BD, Hebl JR, Kent J, Horlocker TT. Neurologic Complications of 405 Consecutive Continuous Axillary Catheters. Anesth Analg. 2003; 96:247–52.
31. Wiegel M, Gottschaldt U, Hennebach R, Hirschberg T, Reske A. Complications and Adverse Effects Associated with Continuous Peripheral Nerve Blocks in Orthopedic Patients. Anesth Analg. 2007; 104:1578–82.
32. Kinirons B, Mimoz O , Lafendi L, Naas T, Jean-François Meunier JF, Nordmann P. Chlorhexidine versus Povidone Iodine in Preventing Colonization of Continuous Epidural Catheters in Children. Anesthesiology. 2001; 94:239–44.
33. Culligan PJ, Kubik K, Miles Murphy M, Blackwell L, Snyder J. A randomized trial that compared povidone iodine and chlorhexidine as antiseptics for vaginal hysterectomy. American Journal of Obstetrics and Gynecology. 2005; 192: 422–5.
34. Darouiche RO, Wall MJ, Itani KMF, Otterson MF, Webb AL, Carrick MM et al. Chlorhexidine–Alcohol versus Povidone–Iodine for Surgical-Site Antisepsis. N Engl J Med. 2010; 362:18-26.
35. Krobbuaban B, Diregpoke S, Prasan S, Thanomsat M, Kumkeaw S. Alcohol-based chlorhexidine vs. povidone iodine in reducing skin colonization prior to regional anesthesia procedures. J Med Assoc Thai. 2011; 94(7): 807-12.
36. Dumville JC, McFarlane E, Edwards P, Lipp A, Holmes A, Liu Z. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database of Systematic Reviews. 2015, Issue 4.
37. Yoshii T, Hirai T, Yamada T, Sakai K, Ushio S, Egawa S et al. A Prospective Comparative Study in Skin Antiseptic Solutions for Posterior Spine Surgeries. Chlorhexidine-Gluconate Ethanol Versus Povidone-Iodine. Clin Spine Surg. 2018; 31(7): E353-E356.
38. Sakuragi T, Yanagisawa K, Dan K. Bactericidal activity of skin disinfectants on methicillin-resistant Staphylococcus aureus. Anesthesia and Analgesia 1995; 81: 555–8.
39. Killeen T, Kamat A, Walsh D, Parker A, A. Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review. Anaesthesia. 2012; 67(12): 1386-94.
40. Bogod D. The sting in the tail: antiseptics and the neuraxis revisited. Anaesthesia. 2012; 67:1305–20.
41. Association of Anaesthetists of Great Britain & Ireland. Safety guideline: skin antisepsis for central neuraxial blockade. Anaesthesia (ePub ahead of print, 3 Sep 2014): doi: 10.1111/anae.12844.
42. De Cicco M, Matovic M, Castellani GT, Basaglia G, Santini G, Del Pup C, Fantin D, Testa V. Time-dependent efficacy of bacterial filters and infection risk in long-term epidural catheterization. Anesthesiology. 1995; 82: 765-771.
43. Saady A. Epidural abscess complicating thoracic epidural analgesia. Anesthesiology. 1976; 44:244-246.
44. Borum SE, McLeskey CH, Williamson JB, Harris FS, Knight AB. Epidural Abscess after Obstetric Epidural Analgesia. Anesthesiology. 1995; 82: 1523-1526.
45. Kaushal M, Narayan S, Aggarwal R, Kapil A, Deorari AK. In vitro use of Epidural Filters for Prevention of Bacterial Infection. INDIAN PEDIATRICS. 2004; 41(17): 1133-1137.
46. Morris W, Simon L, Tryfa M, Pelle-Lancien E, Masson F. Efficiency of antibacterial filters for epidural catheters in obstetrics: preliminary results. European Journal of Anaesthesiology. 2001; 18: 110.
47. Timsit JF, Bruneel F, Cheval C, Mamzer MF, Orgeas MG, Wolff M et al. Use of Tunneled Femoral Catheters To Prevent Catheter Related Infection. Ann Intern Med. 1999; 130: 729-735.
48. Kumar N, Chambers WA. Tunnelling epidural catheters: a worthwhile exercise? Anaesthesia. 2000; 55: 625–626.
49. Marhofer D, Marhofer P, Triffterer L, Leonhardt M, Weber M, Zeitlinger M. Dislocation rates of perineural catheters: a volunteer study. British Journal of Anaesthesia. 2003; 111 (5): 800–6.
50. BURSTAL R, WEGENER F, HAYES C, LANTRY G. Subcutaneous Tunnelling of Epidural Catheters for Postoperative Analgesia to Prevent Accidental Dislodgement: A Randomized Controlled Trial. Anaesth Intens Care 1998; 26: 147-151.
51. Bougher RJ, Corbett AR, Ramage DTO. The effect of tunnelling on epidural catheter migration. Anaesthesia. 1996; 51: 191-194.
52. Sellmann T, Bierfischer V, Schmitz A, Weiss M, Rabenalt S, MacKenzie C, et al. Tunneling and Suture of Thoracic Epidural Catheters Decrease the Incidence of Catheter Dislodgement. The Scientific World Journal Volume 2014, Article ID 610635, 9 pages.
53. Byrne KPA, Freeman VY. Force of removal for untunnelled, tunnelled and double-tunnelled peripheral nerve catheters. Anaesthesia. 2014; 69: 245–248.
54. Bomberg H, Kubulus C, Herberger S, Wagenpfeil S, Kessler P, Steinfeldt T, et al. Tunnelling of thoracic epidural catheters is associated with fewer catheter-related infections: a retrospective registry analysis. British Journal of Anaesthesia. 2016; 116 (4): 546–53.
55. Compe`re V, Legrand JF, Guitard PG, Azougagh K, Baert O, Ouennich A, et al. Bacterial Colonization After Tunneling in 402 Perineural Catheters: A Prospective Study. Anesth Analg 2009; 108: 1326–30.
56. MANN TJ, ORLIKOWSKI CE, GURRIN LC, KEIL AD. The Effect of the Biopatch, a Chlorhexidine Impregnated Dressing, on Bacterial Colonization of Epidural Catheter Exit Sites. Anaesth Intensive Care 2001; 29: 600-603.
57. Ho KM, Litton E. Use of chlorhexidine-impregnated dressing to prevent vascular and epidural catheter colonization and infection: a meta-analysis. Journal of Antimicrobial Chemotherapy. 2006; 58: 281–287.
58. Kerwat K, Eberhart L, Kerwat M, Hörth D, Wulf H, Steinfeldt T, et al. Chlorhexidine Gluconate Dressings Reduce Bacterial Colonization Rates in Epidural and Peripheral Regional Catheters. BioMed Research International Volume 2015, Article ID 149785, 5 pages http://dx.doi.org/10.1155/2015/149785.
59. Schroeder KM, Jacobs RA, Guite C, Gassner K, Anderson B, Donnelly MJ. Use of a chlorhexidine-impregnated patch does not decrease the incidence of bacterial colonization of femoral nerve catheters: a randomized trial. Can J Anesth. 2012; 59: 950–957.
60. Bomberg H, Krotten D, Kubulus C, Wagenpfeil S, Kessler P, Steinfeldt T, et al. Single-dose Antibiotic Prophylaxis in Regional Anesthesia. Anesthesiology 2016; 125:505-15.

How to Cite this Article: Kulkarni R, Maniar A, Singh N, Ponde V, Gupta K, Danish MA, Roy R, Areti A | Sterility Protocols During Regional Anaesthesia: An AORA Initiative | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 05-12.

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Landmark and PNS Guided Forearm Blocks

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Vol 2 | Issue 1 | January-June 2021 | Page 67-71 | Surajit Giri

Authors: Surajit Giri [1]

[1] Department of Anaesthesia, Pragati Hospital & Research Centre, Sivasagar, Assam.

Address of Correspondence
Dr. Surajit Giri,
Department of Anaesthesia, Pragati Hospital & Research Centre, Sivasagar, Assam.
E-mail: drsurajit_1234@yahoo.com

Introduction

Elbow block is used to provide anaesthesia and analgesia for hand and forearm surgery [1]. Primarily it is used to supplement or augment a proximal brachial plexus block if it is partial or patchy. Therefore elbow block is termed as rescue block by many Anaesthesiologists. In recent years, Ultrasonography(USG) guided distal blocks are studied with proximal brachial plexus block to accelerates anaesthesia onset time and block consistency for forearm surgeries [2]. Good anatomical knowledge of forearm nerves (Fig A) is utmost mandatory to use elbow block as a primary anaesthetic technique for forearm and hand surgeries [3, 4].

References

1. Maga JM, Cooper L, Gebhard RE. Outpatient regional anaesthesia for upper extremity surgery update (2005 to present) distal to shoulder. Int Anaesthesia Clin 2012;50:47-55.
2. Lin E, Choi J, Hadzic A. Peripheral nerve blocks for outpatient surgery: Evidence-based indications. Curr Opin Anaesthesiology 2013;26:467-74.
3. Fredrickson MJ, Ting FS, Chinchanwala S, Boland MR. Concomitant infraclavicular plus distal median, radial, and ulnar nerve blockade accelerates upper extremity anaesthesia and improves block consistency compared with infraclavicular block alone. Br J Anaesth 2011;107:236-42.
4. Stranding S, editor. Upper arm. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. London: Churchill Livingstone; 2016. p. 837-61.
5. Gisela Meier,Johannes Buettner.Atlas of Peripheral Regional Anaesthesia: Anatomy & Technique.3rd edition.Thieme;2013.p.244-63.
6. Sehmbi H, Madjdpour C, Shah UJ, Chin KJ. Ultrasound guided distal peripheral nerve block of the upper limb: A technical review. J Anaesthesiol Clin Pharmacol 2015;31:296-307.
7. Fredrickson MJ, Price DJ. Analgesic effectiveness of ropivacaine 0.2% vs 0.4% via an ultrasound-guided C5-6 root/superior trunk perineural ambulatory catheter. Br J Anaesth 2009;103:434-9.
8. RA McCahon, NM Bedforth. Peripheral nerve block at the elbow and wrist. Continuing Education in Anaesthesia, Critical Care & Pain 2007; 7:42-44.

How to Cite this Article: Giri S | Landmark and PNS Guided Forearm Blocks | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 67-71.

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Block Efficacy Above the Clavicle: Volume of Local Anaesthetic Agents

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Vol 2 | Issue 1 | January-June 2021 | Page 35-39 | T. Sivashanmugam, Archana Areti

Authors: T. Sivashanmugamb [1], Archana Areti [1]

[1] Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute,
Sri Balaji Vidyapeeth Deemed-to-be University, Puducherry, India.

Address of Correspondence

Dr. T. Sivashanmugam,
Professor, Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute,
Sri Balaji Vidyapeeth Deemed-to-be University, Puducherry, India.

E-mail: drsiva95@gmail.com

Introduction

The regional anaesthesiologist’s primary goal is to deposit adequate local anaesthetic (LA) in the vicinity of nerves for the desired effect without complications. Our inability to visualise nerves, during landmark and peripheral nerve stimulation techniques, was the biggest obstacle against accurate deposition. Ultrasound (US) guidance enables accurate deposition of local anaesthetics due to objective and consistent visualisation of target nerves [1]. However, the minimum effective local anaesthetic volume (MELAV) varies among clinicians. Stephan Kapral in 1994 described the first ultrasound-guided supraclavicular brachial plexus block [2]. However, the image quality and the injection technique similar to our present-day practice appeared in 2003, where Vincent Chan et al injected 40 ml of local anaesthetic (LA) volume to achieve a 95% success rate [3]. This article reviews the studies that explored the MELAV for US-guided brachial plexus blocks (BPB) above the clavicle and explores the possible reasons for variations reported by authors and to direct future research for identification of safe and effective local anaesthetic volume for the BPB above the clavicle.

References

1. Karmakar MK, Pakpirom J, Songthamwat B, Areeruk P. High definition ultrasound imaging of the individual elements of the brachial plexus above the clavicle. Regional Anesthesia & Pain Medicine. 2020 May;45(5):344–50.
2. Kapral S, Krafft P, Eibenberger K, Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-Guided Supraclavicular Approach for Regional Anesthesia of the Brachial Plexus: Anesthesia & Analgesia. 1994 Mar;78(3):507-513.
3. Chan VWS, Perlas A, Rawson R, Odukoya O. Ultrasound-Guided Supraclavicular Brachial Plexus Block: Anesthesia & Analgesia. 2003 Nov;1514–7.
4. Saranteas T, Finlayson RJ, Tran DQH. Dose-Finding Methodology for Peripheral Nerve Blocks: Regional Anesthesia and Pain Medicine. 2014;39(6):550–5.
5. Strichartz GR, Pastijn E, Sugimoto K. Neural physiology and local anesthetic action. In: Cousins MJ, Carr DB, Horlocker TT, Bridenbaugh PO, editors. Cousins and Bridenbaugh’s Neural Blockade in Clinical Anaesthesia and Pain Medicine. 4th ed. Lippincott Williams & Wilkins; 2012. 41–43 p.
6. Berthold CH, Martin R, Waxman SG, Kocsis JD, Stys PK. Morphology of normal peripheral axons. In: The Axon [Internet]. Oxford University Press; 1995 [cited 2021 Jan 15]. 22–4 p. Available from: http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780195082937.001.0001/acprof-9780195082937
7. Tran DQH, Dugani S, Correa JA, Dyachenko A, Alsenosy N, Finlayson RJ. Minimum Effective Volume of Lidocaine for Ultrasound-Guided Supraclavicular Block: Regional Anesthesia and Pain Medicine. 2011 Sep;36(5):466–9.
8. Prateek P. Estimation of Minimum Effective Volume of Ropivacaine 0.5% in Ultrasound Guided Supraclavicular Brachial Plexus Nerve Block: A Prospective Clinical Trial. Journal of Anesthesia & Intensive Care Medicine [Internet]. 2018 Feb 27 [cited 2021 Jan 11];5(5). Available from: https://juniperpublishers.com/jaicm/JAICM.MS.ID.555671.php
9. Gupta PK, Hopkins PM. Effect of concentration of local anaesthetic solution on the ED 50 of bupivacaine for supraclavicular brachial plexus block † †Preliminary data from this study were presented to a meeting of Anaesthetic research society and European Society of Regional Anaesthesia. British Journal of Anaesthesia. 2013 Aug;111(2):293–6.
10. Raymond SA, Scott c.Steffensen, Laverne D. Gugino, Gary R. Strichartz. The Role of Length of Nerve Exposed to Local Anesthetics in Impulse Blocking Action. Anesthesia & Analgesia. 1989;(68):563–70.
11. Duggan E, El Beheiry H, Perlas A, Lupu M, Nuica A, Chan VWS, et al. Minimum Effective Volume of Local Anesthetic for Ultrasound-Guided Supraclavicular Brachial Plexus Block: Regional Anesthesia and Pain Medicine. 2009 May;34(3):215–8.
12. Song JG, Jeon DG, Kang BJ, Park KK. Minimum effective volume of mepivacaine for ultrasound-guided supraclavicular block. Korean Journal of Anesthesiology. 2013;65(1):37.
13. Sivashanmugam T, Ray S, Ravishankar M, Jaya V, Selvam E, Karmakar MK. Randomized Comparison of Extrafascial Versus Subfascial Injection of Local Anesthetic During Ultrasound-Guided Supraclavicular Brachial Plexus Block: Regional Anesthesia and Pain Medicine. 2015;40(4):337–43.
14. Sivashanmugam T, R Sripriya, J Gobinath, R Charulatha, M Ravishankar. Truncal injection brachial plexus block: A Description of a novel injection technique and dose finding study. Indian Journal of Anaesthesia. 2020;64(5):415–21.
15. Fredrickson MJ, Smith KR, Wong AC. Importance of Volume and Concentration for Ropivacaine Interscalene Block in Preventing Recovery Room Pain and Minimizing Motor Block after Shoulder Surgery. Anesthesiology. 2010 Jun 1;112(6):1374–81.
16. Bonnel F. Microscopic anatomy of the adult human brachial plexus: An anatomical and histological basis for microsurgery. Microsurgery. 1984;5(3):107–17.
17. Moayeri N, Bigeleisen PE, Groen GJ. Quantitative Architecture of the Brachial Plexus and Surrounding Compartments, and Their Possible Significance for Plexus Blocks. Anesthesiology. 2008 Feb 1;108(2):299–304.
18. 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: Brachial plexus block in the elderly. Acta Anaesthesiologica Scandinavica. 2013 Jul;57(6):761–6.
19. 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: Anesthesia & Analgesia. 2011 Oct;113(4):951–5.
20. Falcão LFR, Perez MV, de Castro I, Yamashita AM, Tardelli MA, Amaral JLG. Minimum effective volume of 0.5% bupivacaine with epinephrine in ultrasound-guided interscalene brachial plexus block. British Journal of Anaesthesia. 2013 Mar;110(3):450–5.
21. Choi S, Wang JJ, Awad IT, McHardy P, Safa B, McCartney CJ. The minimal effective volume (MEAV 95) for interscalene brachial plexus block for surgical anesthesia under sedation: A prospective observational dose finding study. Canadian Journal of Pain. 2017 Jan 1;1(1):8–13.

How to Cite this Article: Sivashanmugam | Block Efficacy Above the Clavicle: Volume of Local Anaesthetic Agents | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 35-39.

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Anatomy of Brachial Plexus Above The Clavicle

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Vol 2 | Issue 1 | January-June 2021 | Page 29-34 | Shivaprakash S, Georg Feigl, Sandeep M. Diwan

Authors: Shivaprakash S [1], Georg Feigl [2], Sandeep M. Diwan [3]

[1] Department of Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India.
[2] Private Universitat Witten/Herdecke gGmbH Alfred-Herrhausen-StraBe 50, D-58448 Witten.
[3] Department of Anaesthesia, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence
Dr. Sandeep Diwan,
Department of Anaesthesia, Sancheti Hospital, Pune, Maharashtra, India.
E-mail: sdiwan14@gmail.com

Introduction

The neck is a compact structure which hosts the aero-digestive and neurovascular structures. Nerve roots arising from the spinal cord form an important network of nerves the ‘Brachial Plexus (BP)’ that innervates the upper limb and lies partly in the posterior triangle of neck and partly in the axilla. The BP is complex matrix sandwiched between muscles proximally and muscles and vessels distally at and above the level of clavicle. It consists of roots, trunks, cords & branches (figure 1). Roots and trunks are supraclavicular, divisions are retro clavicular, cords and their branches are infraclavicular. The position of the plexus relative to the clavicle varies, it is higher in the erect position and lower when recumbent [1]. It is broad and presents little of a plexiform arrangement at its commencement, is narrow opposite the clavicle, divides opposite the coracoid process into numerous branches and becomes broad and forms a denser interlacement in the axilla [2]. Brachial plexus is formed by the ventral rami of lower four cervical nerves and the first thoracic spinal nerves with variable contribution (slender twigs) from the fourth cervical and second thoracic nerve.

References

(1) G.J.Romanes. Cunningham’s Manual of Practical Anatomy, vol 3. 15th ed.Oxford.Oxford university press;2014.Side of the Neck; 26-8.
(2) Henry Gray F.R.S. Gray’s Anatomy: Descriptive and Surgical. London. Parragon . book;2001( Reprint). Brachial plexus; 521-2.
(3) Lanz T, Wachsmuth W. Praktische Anatomie. Berlin, Heidelberg, New York: Springer, 2004.
(4) Hafferl A. Lehrbuch der topographischen Anatomie. Berlin, Heidelberg, New York : Springer, 1969
(5) Feigl GC, Litz RJ, Marhofer P. Reg Anesth Pain Med 1-8; doi:10.1136/rapm-2020- 101435
(6) Singal , T. Gupta, D. Sahni , A. Aggarwal Anatomy of scalenovertebral triangle: A vade mecum for clinicians Anatomie du triangle scalénovertébral : un vade mecum pour les cliniciens A. Morphologie 2020 104 174-181
(7) Reiner A, Kasser R. Relative frequency of a subclavian vs. a transverse cervical origin for the dorsal scapular artery in humans. Anat Rec 1996;244:265–8.
(8) Murata, Hiroaki Sakai, Akiko ; Hadzic, Admir; Sumikawa, Koji The Presence of Transverse Cervical and Dorsal Scapular Arteries at Three Ultrasound Probe Positions Commonly Used in Supraclavicular Brachial Plexus Blockade; Anesthesia & Analgesia: August 2012 – Volume 115 – Issue 2 – p 470-473,

How to Cite this Article: Shivaprakash S, Feigl G, Diwan SM | Anatomy of Brachial Plexus Above The Clavicle | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 29-34.

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Cadaveric Workshop and Implications in Regional Anaesthesia

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Vol 2 | Issue 1 | January-June 2021 | Page 22-28 | Ramkumar Mirle, Sajana Mukundan

Authors: Ramkumar Mirle [1], Sajana Mukundan [1]

[1] Department of Anaesthesia, Columbia Asia Referral Hospital, Yeshwanthpur, Bangalore, Karnataka, India.

Address of Correspondence
Dr. Ram Kumar M. M,
Consultant Anaesthesiologist, Columbia Asia Referral Hospital, Yeshwanthpur, Bangalore, Karnataka, India.
E-mail: mirleram@gmail.com

Introduction

The human cadavers have always been an immense source of knowledge from time immemorial and have been aptly termed as “Silent teachers” [1]. Cadaver dissection has been the basis of teaching anatomy to aspiring anaesthesiologist to develop their skills in regional anaesthesia. The practice of regional anaesthesia has evolved from the landmark based technique eliciting paraesthesia to peripheral nerve stimulation-guided technique and in the recent times to use of ultrasound guided (USG) technique alone or a combination of (PNS) and USG – Dual Modality. Successful regional nerve block technique can be a combination of any of these techniques with the most reliable modality depending on the expertise of the performer. In order to excel we need to be appropriately trained akin to a real-life scenario. The cadaver workshop has not only facilitated understanding anatomy but also helped in acquiring practical clinical skills.

References

1. Loukas M, Lanteri A, Ferrauiola J, Tubbs RS, Maharaja G, Shoja MM, et al. Anatomy in ancient India: A focus on the Susruta Samhita. J Anat. 2010;217(6):646–50.
2. Ghosh SK. Human cadaveric dissection: A historical account from ancient Greece to the modern era. Anat Cell Biol. 2015;48(3):153–69.
3. Bohl M, Bosch P, Hildebrandt S. Medical students’ perceptions of the body donor as a “First Patient” or “Teacher”: A pilot study. Anat Sci Educ. 2011;4(4):208–13.
4. Bharambe V, Puranam V, Manvikar PR, Bajpayee P. Anatomy acts in India: a review. Eur J Anat. 2019;23(6):469–77.
5. Kirchmair L, Entner T, Wissel J, Moriggl B, Kapral S, Mitterschiffthaler G. A study of the paravertebral anatomy for ultrasound-guided posterior lumbar plexus block. Anesth Analg. 2001;93(2):477–81.
6. Wedel DJ. Don’t try this at home! Vol. 91, Anesthesia and analgesia. United States; 2000. p. 771–2.
7. Eisma R, Wilkinson T. From “Silent Teachers” to Models. PLoS Biol. 2014;12(10):1–5.
8. Tsui BCH, Dillane D, Walji AH. Cadaveric ultrasound imaging for training in ultrasound-guided peripheral nerve blocks: Upper extremity. Can J Anesth. 2007;
9. Chuan A, Lim YC, Aneja H, Duce NA, Appleyard R, Forrest K, et al. A randomised controlled trial comparing meat-based with human cadaveric models for teaching ultrasound-guided regional anaesthesia. Anaesthesia. 2016;71(8):921–9.
10. Diwan S, Feigl GESRA19-0487 Cadaveric studies and its impact on regional anaesthesiaRegional Anesthesia & Pain Medicine 2019;44:A60-A62.
11. McDonnell JG, O’Donnell BD, Farrell T, Gough N, Tuite D, Power C, et al. Transversus Abdominis Plane Block: A Cadaveric and Radiological Evaluation. Reg Anesth Pain Med. 2007;32(5):399–404.
12. Tran TMN, Ivanusic JJ, Hebbard P, Barrington MJ. Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: A cadaveric study. Br J Anaesth. 2009;102(1):123–7.
13. Sharma M, Macafee D, Pranesh N, Horgan AF. Construct validity of fresh frozen human cadaver as a training model in minimal access surgery. J Soc Laparoendosc Surg. 2012;16(3):345–52.
14. Munirama S, Eisma R, Columb M, Corner GA, McLeod GA. Physical properties and functional alignment of soft-embalmed Thiel human cadaver when used as a simulator for ultrasound-guided regional anaesthesia. Br J Anaesth. 2016;116(5):699–707.
15. Tsui BCH, Dillane D, Pillay J, Walji A. Ultrasound imaging in cadavers: Training in imaging for regional blockade at the trunk. Can J Anesth. 2008;55(2):105–11.
16. Tube AC, Use FOR, Sacs C. 336 sciencf! 1922;LX(1554).
17. Barrington MJ, Wong DM, Slater B, Ivanusic JJ, Ovens M. Ultrasound-guided regional anesthesia: How much practice do novices require before achieving competency in ultrasound needle visualization using a cadaver model. Reg Anesth Pain Med. 2012;37(3):334–9.
18. Barrington MJ, Ivanusic JJ, Rozen WM, Hebbard P. Spread of injectate after ultrasound-guided subcostal transversus abdominis plane block: A cadaveric study. Anaesthesia. 2009;64(7):745–50.
19. Biswas A, Castanov V, Li Z, Perlas A, Kruisselbrink R, Agur A, et al. Serratus Plane Block: A Cadaveric Study to Evaluate Optimal Injectate Spread. Reg Anesth Pain Med. 2018;43(8):854–8.
20. Carline L, McLeod GA, Lamb C. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks. Br J Anaesth. 2016;117(3):387–94.
21. Vidal E, Giménez H, Forero M, Fajardo M. Erector spinae plane block: A cadaver study to determine its mechanism of action. Rev Española Anestesiol y Reanim (English Ed [Internet]. 2018;65(9):514–9. Available from: http://dx.doi.org/10.1016/j.redare.2018.09.002.

How to Cite this Article: Mirle R, Mukundan S | Cadaveric Workshop and Implications in Regional Anaesthesia | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 22-28.

Acknowledgment: M S Ramaiah Advanced Learning Centre, Bangalore, Karnataka, India.

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