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BMC Anesthesiol 2022 Jun 7;22(1):176. Epub 2022 Jun 7.

Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, South Baixiang, Wenzhou City, 325000, Zhejiang Province, China.

Background: To study the respective peripheral and systemic mechanisms of action of dexmedetomidine, as adjuvant to regional anesthesia, we compared dexmedetomidine added to ropivacaine for mid-forearm nerve blocks, to either systemic-only dexmedetomidine, and to a control with no dexmedetomidine.

Methods: Sixty patients undergoing hand surgery were randomly divided into three groups (n = 20 per group). Each group underwent a triple-nerve (median, radial and ulnar) mid-forearm blocks with 0. Read More

J Neurophysiol 2022 Jun 25;127(6):1629-1641. Epub 2022 May 25.

Department of Psychological Sciences, grid.10025.36University of Liverpool, Liverpool, United Kingdom.

External low-frequency peripheral nerve stimulation (LFS) has been proposed as a novel method for neuropathic pain relief. Previous studies have reported that LFS elicits long-term depression-like effects on human pain perception when delivered at noxious intensities, whereas lower intensities are ineffective. To shed light on cortical regions mediating the effects of LFS, we investigated changes in somatosensory-evoked potentials (SEPs) during four LFS intensities. Read More

Cureus 2022 Apr 12;14(4):e24079. Epub 2022 Apr 12.

Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, USA.

Background The management of pain in patients undergoing open reduction and internal fixation (ORIF) of distal radius fractures (DRFs) remains an area of debate for anesthesiologists due to a variety of block options and no definitive superior technique among these modalities. In this retrospective case series, we compare the efficacy of supraclavicular versus infraclavicular regional nerve blocks for surgical patients undergoing distal radial ORIF operations to determine if one approach was superior. Methodology This retrospective case series included patients undergoing ORIF of a DRF at a tertiary academic medical center between April 28, 2016, and August 23, 2021. Read More

Trials 2022 Apr 12;23(1):295. Epub 2022 Apr 12.

Department of Anesthesiology, Guangdong Provincial People's Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.

Background: Ultrasound-guided intertruncal approach (IA) has been proposed to be an alternative and promising approach to the supraclavicular block (SCB), in which double injection (DI) of local anesthetics (LA) is sequentially administered between intertruncal planes. We would like to apply a refined injection technique, named triple injection (TI) technique, based on the 3 separate compartments visualized by ultrasound. The aim of this study is to compare the percentage of patients with complete sensory blockade at 20 min of DI vs TI technique, when they are applied in patients undergoing upper limb arteriovenous access surgery. Read More

Jt Dis Relat Surg 2022 28;33(1):109-116. Epub 2022 Mar 28.

Antalya Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği, 07100 Muratpaşa, Antalya, Türkiye.

Objectives: The aim of this study was to evaluate the feasibility of the wide-awake local anesthesia no-tourniquet (WALANT) technique in radial shortening osteotomy and to compare it with the infraclavicular brachial plexus block (IBPB).

Patients And Methods: Between January 2020 and January 2021, a total of 26 patients (16 males, 10 females, mean age: 40±4.9 years; range, 29 to 45 years) with Kienbock's disease who underwent radial shortening osteotomy were retrospectively analyzed. Read More

J Anaesthesiol Clin Pharmacol 2021 Oct-Dec;37(4):655-660. Epub 2021 Nov 2.

Department of Anaesthesiology, M S Ramaiah Medical College, Bengaluru, Karnataka, India.

Background And Aims: Brachial plexus is in a very compact state at the costoclavicular space (CCS) when compared to the axilla, where the individual nerves are separate. This study aimed to test the hypothesis that brachial plexus block (BPB) at the CCS would result in a faster onset of block as compared to the axillary approach of BPB.

Material And Methods: Fifty patients who underwent surgeries below the level of mid-arm under ultrasound-guided BPB were randomly allocated to any one of the two study groups. Read More

J Hand Surg Am 2022 Mar 23. Epub 2022 Mar 23.

Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address:

Purpose: To investigate the effect of dynamic stabilizers of the elbow on radiocapitellar joint alignment, before and after the administration of regional anesthesia.

Methods: At a single institution, 14 patients were prospectively enrolled in a study using a within-subjects control design. Before performing a supraclavicular regional block, 10 fluoroscopic images (1 anteroposterior and 9 lateral views) of the elbow were obtained for each patient. Read More

J Clin Anesth 2022 05 29;77:110635. Epub 2021 Dec 29.

Department of Anesthesiology and Critical care, All India Institute of Medical Sciences, Bhubaneswar, India.

J Hand Surg Am 2022 02 7;47(2):172-179. Epub 2021 Dec 7.

Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

Dorsoradial forearm and hand pain was historically considered difficult to treat surgically due to a particular susceptibility of the radial sensory nerve (RSN) to injury and/or compression. A nerve block, if it were done at all, was directed at the region of the anatomic snuff box to block the RSN in an effort to provide diagnostic information as to the pain etiology. Even for patients with pain relief following a diagnostic block, resecting the RSN often proved unsuccessful in fully relieving pain. Read More

Medicine (Baltimore) 2021 Nov;100(46):e27900

Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.

Introduction: Multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) is an asymmetric immune-related neuropathy with conduction block. We report 2 MADSAM cases with detailed clinical, electrophysiological, and sonography profiles.

Patient Concerns And Diagnosis: Two cases presented with patchy sensorimotor impairment in both clinical and electrophysiological findings. Read More

BMC Anesthesiol 2021 11 9;21(1):273. Epub 2021 Nov 9.

Department of Anaesthesiology and Intensive Care, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.

Background: Supraclavicular block (SCB) with long-acting local anaesthetic is commonly used for surgical repair of distal radial fractures (DRF). Studies have shown a risk for rebound pain when the block fades. This randomised single-centre study aimed to compare pain and opioid consumption the first three days post-surgery between SCB-mepivacaine vs. Read More

Rev Esp Anestesiol Reanim (Engl Ed) 2021 Sep 23. Epub 2021 Sep 23.

Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japón.

Anesthetic management using costoclavicular brachial plexus block with patient-controlled analgesia in pediatrics: a case report Abstract The costoclavicular brachial plexus block (CBPB) has been receiving increasing attention as an effective technique for upper arm surgery conducted without phrenic paralysis. However, studies in children are lacking. CBPB was applied to a 10 year-old girl undergoing scheduled radial and ulnar osteotomy due to multiple cartilaginous exostoses and ulnar lengthening. Read More

Cureus 2021 Aug 3;13(8):e16865. Epub 2021 Aug 3.

Anesthesiology and Reanimation Clinic, Bafra State Hospital, Samsun, TUR.

Peripheral nerve blocks with the use of ultrasonography (USG) allow visualisation of both the structures and nerves and make the block administrations safe, quick, and comfortable. However, few publications concerning the minimum local anesthetic (LA) volume are capable of providing blocks. This study aimed to find the minimum effective LA volume in brachial plexus blockage administrations with an axillary approach accompanied by ultrasonography in hand, elbow, and forehand operations. Read More

A A Pract 2021 Aug 19;15(8):e01514. Epub 2021 Aug 19.

From the Department of Anesthesia, Bell Land General Hospital, Sakai, Japan.

Peripheral nerve blocks for postoperative pain management in distal radius fracture fixation with volar locking plates can cause undesirable motor paralysis. We performed bilateral ultrasound-guided selective sensory nerve blocks to the lateral cutaneous nerve of the forearm, superficial branch of the radial nerve, and anterior interosseous nerve for a patient undergoing bilateral distal radius fracture fixation with volar locking plates. This case report describes the first successful use of this ultrasound-guided selective sensory nerve block, which provided satisfactory postoperative analgesia and preserved the patient's motor function following distal radius fracture fixation with volar locking plates. Read More

Braz J Anesthesiol 2022 May-Jun;72(3):372-378. Epub 2021 Aug 8.

Ankara Etlik Zübeyde Hanım Obstetric and Gynecology State Hospital, Anesthesia Department, Ankara, Turkey.

Background: In this prospective, randomized, controlled observer-blinded study, we aimed to compare the efficacy of a single-operator technique called the Jedi Grip and a conventional technique requiring a double operator in ultrasound-guided axillary brachial plexus blocking.

Methods: Ninety-two patients (ASA I-II; aged 18-65 years old) who underwent elective hand, wrist and forearm surgery were randomly assigned to Group Conventional (C) or Group Jedi (J). In both groups, axillary plexus blockade was performed by applying 5 cc of a mixture of 10 cc of 0. Read More

Vet Anaesth Analg 2021 Sep 8;48(5):815-817. Epub 2021 Jul 8.

Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.

Anaesth Crit Care Pain Med 2021 08 23;40(4):100914. Epub 2021 Jun 23.

Department of Anaesthesia and Intensive Care, University Hospital Kerry, Tralee, Kerry, Ireland. Electronic address:

JBJS Essent Surg Tech 2020 Oct-Dec;10(4). Epub 2020 Nov 19.

Texas Children's Hospital, Houston, Texas.

Background: Sedated, closed reduction of a displaced distal radial fracture followed by cast immobilization is indicated in cases of unacceptable alignment on post-splint imaging. The aim of this procedure is to obtain acceptable reduction and cast immobilization for fracture-healing.

Description: The patient is positioned supine with the injured arm on the image intensifier. Read More

BMC Anesthesiol 2021 05 29;21(1):164. Epub 2021 May 29.

Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, China.

Background: An increase in blood flow in the forearm arteries has been reported after brachial plexus block (BPB). However, few studies have quantitatively analysed the blood flow of the forearm arteries after BPB or have studied only partial haemodynamic parameters. The purpose of the present study was to comprehensively assess blood flow changes in the distal radial artery (RA) and ulnar artery (UA) after BPB performed via a new costoclavicular space (CCS) approach using colour Doppler ultrasound. Read More

Bone Jt Open 2021 May;2(5):338-343

Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK.

Aims: Displaced distal radius fractures were investigated at a level 1 major trauma centre during the COVID-19 2020 lockdown due to the implementation of temporary changes in practice. The primary aim was to establish if follow-up at one week in place of the 72-hour British Orthopaedic Association Standards for Trauma & Orthopaedics (BOAST) guidance was safe following manipulation under anaesthetic. A parallel adaptation during lockdown was the non-expectation of Bier's block. Read More

Br J Anaesth 2021 07 15;127(1):153-163. Epub 2021 May 15.

Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medical BioPhysics, University of Toronto, Toronto, Canada.

Background: Nerve damage is consistently demonstrated after subepineural injection in animal studies, but not after purposeful injection in patients participating in clinical studies. There is a need to better visualise nerves in order to understand the structural changes that occur during subepineural injection.

Methods: We scanned the brachial plexuses of three anaesthetised pigs using micro-ultrasound imaging (55-22 MHz probe), inserted 21 gauge block needles into the radial, median, and axillary nerves, and injected two 0. Read More

J Neurol Surg A Cent Eur Neurosurg 2021 Jul 12;82(4):392-396. Epub 2021 Apr 12.

Department of Neurology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy.

Our case report underscores the importance of electroneuromyography (ENMG) combined with peripheral nerve high-resolution ultrasound (HRUS) in the evaluation of neurofibromatosis type 1 (NF1). A 49-year-old woman affected by NF1 came to our attention because of new-onset left arm weakness and atrophy. Debulking of a cervicothoracic C7-T1 neurofibroma had been performed 8 years earlier. Read More

Anaesth Crit Care Pain Med 2021 04 18;40(2):100831. Epub 2021 Mar 18.

Department of Burn & Plastic Surgery, All India Institute of Medical Sciences (AIIMS), Patna, India.

Background And Aims: Radial artery is a common site of cannulation in acute care setting. There are conflicting reports as to which nerve, radial or median or both supplies the radial artery. We did this prospective study in patients undergoing minor procedures under peripheral nerve blocks to ascertain which nerve block, radial or median increases the cross sectional area and blood flow in the radial artery. Read More

Cureus 2021 Jan 13;13(1):e12691. Epub 2021 Jan 13.

Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS.

Introduction Closed reduction is an effective method of treatment for distal end radius fractures. We present a case series of patients with distal end radius fractures who underwent closed manipulative reduction using the periosteal block. We describe the technique in detail and examine its efficacy in pain lowering effect during closed reduction. Read More

Pain Physician 2021 01;24(1):E15-E21

Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, South Korea.

Background: The brachial plexus courses along the lateral to posterior aspect of the subclavian artery located within the supraclavicular region as a trunk or division. Therefore we hypothesized that 2 injections, one along the lateral and one along the posterior aspect of the brachial plexus, could be performed by changing the angle of the ultrasound probe, thereby achieving a 3-dimensional (3-D) even distribution of local anesthetics. Previously, we confirmed the efficacy of this type of approach with that of a single cluster approach. Read More

World Neurosurg 2021 05 27;149:453-460. Epub 2020 Nov 27.

Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China. Electronic address:

Objective: In the present study, we explored the clinical effect of midazolam as an adjuvant analgesic and tranquilizer after brachial plexus block anesthesia with the aid of imaging guidance.

Methods: We selected 106 patients who had undergone elective unilateral upper extremity surgery from January 2017 to December 2019 and randomly divided them into groups A and B, with 53 cases in each group. All the patients had undergone brachial plexus block anesthesia. Read More

Eplasty 2020 19;20:e12. Epub 2020 Oct 19.

Division of Plastic and Reconstructive Surgery, Department of Surgery.

Use of local anesthesia in awake patients undergoing hand surgery has become increasingly popular. A thorough understanding of local anatomy, such as the distal wrist for ulnar nerve block, is required to provide safe blockade. We sought to conduct an anatomic study of the distal wrist and review cadaveric studies describing various techniques for ulnar nerve block. Read More

Medicine (Baltimore) 2020 Oct;99(43):e22739

Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Anam Hospital, Seoul.

Objectives: It was recently proposed that a costoclavicular (CC) approach can be used in ultrasound (US)-guided infraclavicular brachial plexus block (BPB). In this study, we hypothesized that triple injections in each of the 3 cords in the CC space would result in a greater spread in the 4 major terminal nerves of the brachial plexus than a single injection in the CC space without increasing the local anesthetic (LA) volume.

Methods: Sixty-eight patients who underwent upper extremity surgery randomly received either a single injection (SI group, n = 34) or a triple injection (TI group, n = 34) using the CC approach. Read More

J Shoulder Elbow Surg 2021 Jul 20;30(7):1603-1612. Epub 2020 Oct 20.

Department of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA.

Background: The incidence of nerve injuries in revision total shoulder arthroplasty (TSA) is not well defined in the literature and may be higher than that in primary procedures, with 1 study reporting a complication rate of 50% for shoulder revisions. Given that continuous intraoperative nerve monitoring (IONM) can be an effective tool in diagnosing evolving neurologic dysfunction and preventing postoperative injuries, the purpose of this study was to report on IONM data and nerve injury rates in a series of revision TSAs.

Methods: A retrospective cohort review of consecutive patients who underwent revision TSA was performed from January 2016 to March 2020. Read More

Rehabilitacion (Madr) 2021 Apr-Jun;55(2):153-156. Epub 2020 Oct 14.

Servicio de Rehabilitación, Complexo Hospitalario Universitario A Coruña, A Coruña, España.

The radial nerve has a long and sinuous course in the upper limb from the axilla to the hand and fingers. There are several possible areas of compression along this trajectory, the most frequent being on the Arcade of Frohse, with entrapment of its terminal nerve, the posterior interosseous nerve. We report the case of a patient with radial nerve entrapment in the spiral groove and describe how ultrasound and nerve blocks could be useful in diagnosis and treatment. Read More