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

June 10, 2024/1,104 Comments/in Volume 5; Issue 1: January-June 2024/by Ijraijraadmin

Vol 5 | Issue 1 | January-June 2024 | Page 14-17| Harshal D Wagh , Chetan Salunkhe , Mitalee Pareek , Senthil Kumar DOI: https://doi.org/10.13107/ijra.2024.v05.i01.085 Authors: Harshal D Wagh [1], Chetan Salunkhe [1], Mitalee Pareek [1], Senthil Kumar [1] [1] Department of Anaesthesia, Kokilaben Dirubhai Ambani Hospital, Mumbai, Maharashtra, India. Address of Correspondence Dr. […]

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

June 10, 2024/1,012 Comments/in Volume 5; Issue 1: January-June 2024/by Ijraijraadmin

Vol 5 | Issue 1 | January-June 2024 | Page 18-23| Tanvir Samra, Pankaj Kushal, Vikas Saini, Sameer Sethi, Rahul Kathuria, Anjuman Chander DOI: https://doi.org/10.13107/ijra.2024.v05.i01.086 Authors: Tanvir Samra [1], Pankaj Kushal [1], Vikas Saini [1], Sameer Sethi [1], Rahul Kathuria [2], Anjuman Chander [1] [1] Department of Anaesthesia, Postgraduate Institute of Medical Education and […]

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

June 10, 2024/1,104 Comments/in Volume 5; Issue 1: January-June 2024/by Ijraijraadmin

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

June 10, 2024/1,012 Comments/in Volume 5; Issue 1: January-June 2024/by Ijraijraadmin

Full Sized Blog Element (Big Preview Pic)

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

June 10, 2024/1,104 Comments/in Volume 5; Issue 1: January-June 2024/by Ijraijraadmin

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

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

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

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

Address of Correspondence

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

Abstract

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

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

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

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

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

References

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

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

June 10, 2024/1,012 Comments/in Volume 5; Issue 1: January-June 2024/by Ijraijraadmin

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

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

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

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

Address of Correspondence

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

Abstract

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

References

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

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

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

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

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

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

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

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

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

(Abstract Text HTML) (Download PDF)

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