An Observational Study of Efficacy of Infraclavicular Brachial Plexus Block for Arterio-Venous Fistula Surgeries- Comparison of Two Techniques Using Ultrasound and Ultrasound with Peripheral Nerve Stimulation

Vol 3 | Issue 2 | July-December 2022 | Page 88-92 | Trupti Pethkar, R. Janki

DOI: 10.13107/ijra.2022.v03i02.060


Authors: Trupti Pethkar [1], R. Janki [1]

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

[2] Critical Care Department, Caritas Hospital, Kottayam, Kerala, India.

Address of Correspondence
Dr. Trupti Pethkar,
Consultant Anesthesiologist, Department of Anaesthesia, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.
E-mail: truptipethkar@yahoo.co.in


Abstract

Background: Success of the brachial plexus block depends equally on the performer’s skill and the availability of specific equipments. Here, the efficacy of infraclavicular brachial plexus block was assessed using two different techniques.
Material and Methods: In 72 patients divided in equal groups, the time taken to perform the block, onset and degree of sensory and motor blockade, complications and supplements, if required were noted in patients undergoing arterio-venous fistula creation. An infraclavicular brachial plexus block was performed either with ultrasound only (group-A) or with ultrasound and nerve stimulation (group-B). Collected data underwent rigorous statistical analysis.
Results: Onset of sensory, motor blockade and block success achieved in both groups was statistically insignificant. Time taken for block administration and the mean time for complete sensory blockade were statistically significant.
Conclusion: Though time taken for the block administration was longer and complete sensory blockade was earlier by dual guidance, the block success rate and the degree of block were comparable in both the techniques. Dual modality blocks are challenging in view of obtaining an evoked motor response and visualization of the needle at the same time.
Keywords: Infraclavicular brachial plexus block, Sonosite, Peripheral nerve Stimulator


References


1. Emmannuel Dingemans, Stephan R. Williams, Genevie `ve Arcand, Philippe Chouinard, Patrick Harris, Monique Ruel, RN* Franc ¸ois Girard et al. Neurostimulation in ultrasound guided Infraclavicular Block: A Prospective Trial. Anaesth Analg 2007; 104; 1275-80.
2. Y. Gürkan, M. Tekin, S. Acar, M. Solak and K. Toker. Is nerve stimulation needed during an ultrasound-guided lateral sagittal infraclavicular block? Acta Anaesthesiol Scand 2010; 54: 403–407.
3. FMT Azmin & YC Choy. Regional infraclavicular blocks via the coracoid approach for below-elbow surgery: a comparison between ultrasound guidance with, or without, nerve stimulation, South Afr J Anaesth Analg 2013, 19(5):263-269.
4. Shrestha BR. Nerve Stimulation Under Ultrasound Guidance Expedites Onset of Axillary Brachial Plexus Block. J Nepal Health Res Counc 2011 Oct; 9(19):145-49.
5. Bloc S, Garnier T, Komly B, Leclerc P, Mercadal L, Morel B, Dhonneur G. Ultrasound-guided infraclavicular block: a preliminary study of feasibility. Ann Fr Anesth Reanim 2007; 26: 627–37.
6. Chan VWS, Perlas A, McCartney CJL, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth. 2007; 54: 176-182.
7. Richard Brull, MD Æ Mario Lupu, MD Æ Anahi Perlas, MD Æ Vincent W. S. Chan, MD Æ Colin J. L. McCartney, MB. Compared with dual nerve stimulation, ultrasound guidance shortens the time for infraclavicular block performance.Can J Anaesth 2009 Nov; 56(11): 812-8.


How to Cite this Article: Pethkar T, Janki R | An Observational Study of Efficacy of Infraclavicular Brachial Plexus Block for Arterio-Venous Fistula Surgeries- Comparison of Two Techniques Using Ultrasound and Ultrasound with Peripheral Nerve Stimulation | International Journal of Regional Anaesthesia | July-December 2022; 3(2): 88-92.


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Time to adequately heed Acute Pain in the Emergency Department – More Regional Blocks Warranted

Vol 3 | Issue 2 | July-December 2022 | Page 37-41 | Tom C. R. V. Van Zundert, André A. J. Van Zundert

DOI: 10.13107/ijra.2022.v03i02.054


Authors: Tom C. R. V. Van Zundert [1, 2], André A. J. Van Zundert [2, 3]

[1] Department of Emergency Medicine, Holy Heart Hospital, Mol, Belgium.
[2] Udayana University, Bali, Indonesia.
[3] Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital and The University of Queensland, Brisbane, QLD, Australia.

Address of Correspondence
Professor André A.J. Van Zundert,
Professor and Chair of Anaesthesiology, Royal Brisbane and Women’s Hospital & The University of Queensland, Brisbane, QLD, Australia.
E-mail: vanzundertandre@gmail.com


Introduction

All healthcare stressors converge in the emergency department (ED), which sees an annual increase of 6-7% with more than 25 million patient visits in the UK. This translates to 44,435 attendances per 100,000 population in the period 2019-2020 [1]. Acute pain is the primary reason patients seek emergency medical care. Consequently, substandard acute pain treatment is one of the most frequently heard complaints and has been labelled as a public health problem [2]. Pain remains under-acknowledged, -assessed and -treated, mainly in case of overcrowding in the ED and especially in the more vulnerable groups, including the elderly and children. Many patients express an initial pain score of 10 out of 10 on the visual analogue scale (VAS) in the ED. Generally, initial pain treatment combines oral acetaminophen, NSAID and/or (IV) opioids. Nevertheless, despite these pain killers, most patients continue to suffer and score their pain at 8/10 or higher. Untreated pain can have both short- and long-term effects, including sensitisation to pain episodes in later life [3].

Most visits to the emergency department involve patients with conditions that include: a) injuries and trauma from (motor vehicle) accidents, physical assaults or falls, with or without circulatory shock; b) cardiovascular and cerebral attacks or loss of consciousness; c) severe pain of diverse causes, both acute and chronic origin; d) acute worsening of a serious illness or disease, including problems with breathing and bleeding; e) mental illness; f) burns; g) anaphylactic and allergic reactions; g) drug overdoses and poisoning; and h) pregnancy-related complications. In most of these cases, patients present with pain as a substantial factor.

Keywords: Emergency department, Hip fracture, Pain, Regional anaesthesia, Nerve blocks, Ultrasonography


References


1. NHS Report. Hospital Accident & Emergency Activity 2020-21. 30.09.2021. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-accident–emergency-activity/2020-21# (accessed 20.05.2022).
2. Keating L, Smith S. Acute Pain in the Emergency Department: The Challenges. Rev Pain. 2011;5(3):13-17.
3. Duggan NM, Nagdev A, Hayes BD, Shokoohi H, Selame LA, Liteplo AS, Goldsmith AJ. Perineural Dexamethasone as a Peripheral Nerve Block Adjuvant in the Emergency Department: A Case Series. J Emerg Med. 2021 Nov;61(5):574-580.
4. Verbeek T, Adhikary S, Urman R, Liu H. The Application of Fascia Iliaca Compartment Block for Acute Pain Control of Hip Fracture and Surgery. Curr Pain Headache Rep. 2021 Mar 11;25(4):22.
5. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury 2018;49:1458-1460.
6. Amin NH, West JA, Farmer T, Basmajian HG. Nerve Blocks in the Geriatric Patient With Hip Fracture: A Review of the Current Literature and Relevant Neuroanatomy. Geriatr Orthop Surg Rehabil. 2017 Dec;8(4):268-275.
7. Salottolo K, Meinig R, Fine L, Kelly M, Madayag R, Ekengren F, Tanner A, Roman P, Bar-Or D. A multi-institutional prospective observational study to evaluate fascia iliaca compartment block (FICB) for preventing delirium in adults with hip fracture. Trauma Surgery & Acute Care Open 2022;7:e000904.
8. Hao J, Dong B, Zhang J, Luo Z. Pre-emptive analgesia with continuous fascia iliaca compartment block reduces postoperative delirium in elderly patients with hip fracture. A randomized controlled trial. Saudi Med J. 2019 Sep;40(9):901-906.
9. Lee HK, Kang BS, Kim CS, Choi HJ. Ultrasound-guided regional anaesthesia for the pain management of elderly patients with hip fractures in the emergency department. Clin Exp Emerg Med. 2014 Sep 30;1(1):49-55.
10. Hards M, Brewer A, Bessant G, Lahiri S. Efficacy of Prehospital Analgesia with Fascia Iliaca Compartment Block for Femoral Bone Fractures: A Systematic Review. Prehosp Disaster Med. 2018 Jun;33(3):299-307.
11. Okereke IC, Abdelmonem M. Fascia Iliaca Compartment Block for Hip Fractures: Improving Clinical Practice by Audit. Cureus. 2021;13:e17836. doi: 10.7759/cureus.17836
12. Nice Guidelines. The management of hip fracture in adults. Updated 2019. https://www.nice.org.uk/guidance/cg124/evidence/full-guideline-pdf-183081997 (accessed 24.05.2022).
13. Butler MM, Ancona RM, Beauchamp GA, Yamin CK, Winstanley EL, Hart KW, Ruffner AH, Ryan SW, Ryan RJ, Lindsell CJ, Lyons MS. Emergency Department Prescription Opioids as an Initial Exposure Preceding Addiction. Ann Emerg Med. 2016 Aug;68(2):202-8.
14. Ketelaars R, Stollman JT, van Eeten E, Eikendal T, Bruhn J, van Geffen G-J. Emergency physician-performed ultrasound-guided nerve blocks in proximal femoral fractures provide safe and effective pain relief: a prospective observational study in The Netherlands. Int J Emerg Med 2018;11:12.
15. Reavley P, Montgomery AA, Smith JE, Binks S, Edwards J, Elder G, Benger J. Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department. Emerg Med J. 2015;32:685-689.
16. Nagel EM, Gantioque R, Taira T. Utilizing Ultrasound-Guided Femoral Nerve Blocks and Fascia Iliaca Compartment Blocks for Proximal Femur Fractures in the Emergency Department. Adv Emerg Nurs J. 2019 Apr/Jun;41(2):135-144.
17. Luftig J, Mantuani D, Herring AA, Dixon B, Clattenburg E, Nagdev A. Successful emergency pain control for posterior rib fractures with ultrasound-guided erector spinae plane block. Am J Emerg Med. 2018 Aug;36(8):1391-1396.
18. Ritcey B, Pageau P, Woo MY, Perry JJ. Regional Nerve Blocks For Hip and Femoral Neck Fractures in the Emergency Department: A Systematic Review. CJEM. 2016 Jan;18(1):37-47.
19. Jaffe TA, Shokoohi H, Liteplo A, Goldsmith A. A Novel Application of Ultrasound-Guided Interscalene Anaesthesia for Proximal Humeral Fractures. The Journal of Emergency Medicine. 2020;59:265-269.
20. De Buck F, Devroe S, Missant C, Van de Velde M. Regional anaesthesia outside the operating room: indications and techniques. Curr Opin Anaesthesiol. 2012 Aug;25(4):501-7.
21. Steenberg J, Møller AM. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br J Anaesth. 2018 Jun;120(6):1368-1380.
22. Scarpa J, Wu CL. The role for regional anaesthesia in medical emergencies during deep space flight. Reg Anesth Pain Med. 2021 Oct;46(10):919-922.
23. Cappelleri G, Fanelli A, Ghisi D, Russo G, Giorgi A, Torrano V, Lo Bianco G, Salomone S, Fumagalli R. The Role of Regional Anaesthesia During the SARS-CoV2 Pandemic: Appraisal of Clinical, Pharmacological and Organizational Aspects. Front Pharmacol. 2021 Jun 4;12:574091.
24. Wiercigroch D, Ben-Yakov M, Porplycia D, Friedman SM. Regional anaesthesia in Canadian emergency departments: Emergency physician practices, perspectives, and barriers to use. CJEM. 2020 Jul;22(4):499-503.
25. Herring AA. Bringing Ultrasound-guided Regional Anaesthesia to Emergency Medicine. AEM Educ Train. 2017 Mar 29;1(2):165-168.


How to Cite this Article: Van Zundert TCRV, Van Zundert AAJ | Time to Adequately Heed Acute Pain in the Emergency Department- More Regional Blocks Warranted | International Journal of Regional Anaesthesia | July-December 2022; 3(2): 37-41.


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