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Sonawane K, Dixit H, Thota N, Mistry T, Balavenkatasubramanian J. "Knowing It Before Blocking It," the ABCD of the Peripheral Nerves: Part B (Nerve Injury Types, Mechanisms, and Pathogenesis). Cureus 2023; 15:e43143. [PMID: 37692583 PMCID: PMC10484240 DOI: 10.7759/cureus.43143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Selander emphatically said, "Handle these nerves with care," and those words still echo, conveying a loud and clear message that, however rare, peripheral nerve injury (PNI) remains a perturbing possibility that cannot be ignored. The unprecedented nerve injuries associated with peripheral nerve blocks (PNBs) can be most tormenting for the unfortunate patient and a nightmare for the anesthetist. Possible justifications for the seemingly infrequent occurrences of PNB-related PNIs include a lack of documentation/reporting, improper aftercare, or associated legal implications. Although they make up only a small portion of medicolegal claims, they are sometimes difficult to defend. The most common allegations are attributed to insufficient informed consent; preventable damage to a nerve(s); delay in diagnosis, referral, or treatment; misdiagnosis, and inappropriate treatment and follow-up care. Also, sufficient prospective studies or randomized trials have not been conducted, as exploring such nerve injuries (PNB-related) in living patients or volunteers may be impractical or unethical. Understanding the pathophysiology of various types of nerve injury is vital to dealing with them further. Processes like degeneration, regeneration, remyelination, and reinnervation can influence the findings of electrophysiological studies. Events occurring in such a process and their impact during the assessment determine the prognosis and the need for further interventions. This educational review describes various types of PNB-related nerve injuries and their associated pathophysiology.
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Affiliation(s)
- Kartik Sonawane
- Anesthesiology, Ganga Medical Centre and Hospitals, Coimbatore, IND
| | - Hrudini Dixit
- Anesthesiology, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND
| | - Navya Thota
- Anesthesiology, Ganga Medical Centre and Hospitals, Coimbatore, IND
| | - Tuhin Mistry
- Anesthesiology, Ganga Medical Centre and Hospitals, Coimbatore, IND
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Lam KHS, Lai WW, Ngai HY, Wu WKR, Wu YT. Comment on the safety of the ultrasound-guided hydrodissection technique for carpal tunnel syndrome. J Ultrasound 2022; 26:285-287. [PMID: 35171496 PMCID: PMC10063760 DOI: 10.1007/s40477-022-00664-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/14/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Unit 305 Telford House, 16 Wang Hoi Road, Kowloon Bay, Kowloon, Hong Kong. .,Department of Family Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong. .,Department of Family Medicine, The University of Hong Kong, Hong Kong, Hong Kong. .,Taiwan Association of Prolotherapy and Regenerative Medicine, Taichung, Taiwan. .,Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Wai Wah Lai
- The Hong Kong Institute of Musculoskeletal Medicine, Unit 305 Telford House, 16 Wang Hoi Road, Kowloon Bay, Kowloon, Hong Kong.,Department of Family Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ho Yin Ngai
- The Hong Kong Institute of Musculoskeletal Medicine, Unit 305 Telford House, 16 Wang Hoi Road, Kowloon Bay, Kowloon, Hong Kong.,Department of Family Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wing Keung Ricky Wu
- The Hong Kong Institute of Musculoskeletal Medicine, Unit 305 Telford House, 16 Wang Hoi Road, Kowloon Bay, Kowloon, Hong Kong.,Department of Family Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,Department of Family Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Research and Development, School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Phan KH, Anderson JG, Bohay DR. Complications Associated with Peripheral Nerve Blocks. Orthop Clin North Am 2021; 52:279-290. [PMID: 34053573 DOI: 10.1016/j.ocl.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Outpatient orthopedic surgery is gradually becoming the standard across the country, as it has been found to significantly lower costs without compromising patient care. Peripheral nerve blocks (PNBs) are largely what have made this transition possible by providing patients excellent pain control in the immediate postoperative period. However, with the increasing use of PNBs, it is important to recognize that they are not without complications. Although rare, these complications can cause patients a significant amount of morbidity. It is important for surgeons to know the risks of peripheral nerve blocks and to inform their patients.
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Affiliation(s)
- Kevin H Phan
- Orthopaedic Associates of Michigan, 1111 Leffingwell Avenue Northeast, Grand Rapids, MI 49525, USA.
| | - John G Anderson
- Orthopaedic Associates of Michigan, 1111 Leffingwell Avenue Northeast, Grand Rapids, MI 49525, USA
| | - Donald R Bohay
- Orthopaedic Associates of Michigan, 1111 Leffingwell Avenue Northeast, Grand Rapids, MI 49525, USA
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Liu HL, Zhou RH, Luo LL, Yuan X, Ye L, Luo HG. Ultrasound-Guided Transversus Abdominis Plane Block for Cesarean Delivery: Injection Site Pain as a New Complication and Dexamethasone Reduced Incidence. J Pain Res 2020; 13:565-573. [PMID: 32256104 PMCID: PMC7090204 DOI: 10.2147/jpr.s222767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 03/07/2020] [Indexed: 02/05/2023] Open
Abstract
Background Although ultrasound-guided transversus abdominis plane block (TAPB) is widely used in multimodal analgesia after cesarean delivery (CD), the complications of TAPB during analgesia after CD have rarely been reported. Methods A total of 84 cases of CD were randomly assigned to either a ropivacaine group (R group) or ropivacaine + dexamethasone group (RD group) in this double-blind trial. The pain site and pain degree at rest and during activity at 2 h, 6 h, 10 h, 12 h, 14 h, 16 h, 20 h, and 24 h after maternal surgery were recorded. The consumption of opioids at 24h, postoperative nausea, vomiting, exhaustion, and other adverse reactions were recorded. Results A total of 80 patients were included in the analysis of results. A total of 19 patients developed ISP, 14 in the R group and 5 in the RD group. The incidence of ISP in the R and RD groups was 35% and 12.5%, respectively. The results described above showed that combining dexamethasone with ropivacaine reduced the incidence of ISP, and the difference was statistically significant (P<0.05). Two groups of women with positive ISP had higher values of opioid consumption than women with negative ISP, but the difference was not significant. Conclusion Dexamethasone as an adjuvant for ropivacaine can effectively relieve the ISP of ultrasound-guided TAPB after CD, and can enhance the analgesic effect of ropivacaine.
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Affiliation(s)
- Hai-Lin Liu
- Department of Anesthesiology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, People's Republic of China
| | - Rui-Hao Zhou
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Li-Li Luo
- Department of Anesthesiology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, People's Republic of China
| | - Xue Yuan
- Department of Anesthesiology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, People's Republic of China
| | - Ling Ye
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - He-Guo Luo
- Department of Anesthesiology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330008, People's Republic of China
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Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8284363. [PMID: 29226150 PMCID: PMC5684553 DOI: 10.1155/2017/8284363] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/19/2017] [Accepted: 06/28/2017] [Indexed: 02/02/2023]
Abstract
Purpose of Review Transversus abdominis plane (TAP) block is a regional technique for analgesia of the anterolateral abdominal wall. This review highlights the nomenclature system and recent advances in TAP block techniques and proposes directions for future research. Recent Findings Ultrasound guidance is now considered the gold standard in TAP blocks. It is easy to acquire ultrasound images; it can be used in many surgeries involving the anterolateral abdominal wall. However, the efficacy of ultrasound-guided TAP blocks is not consistent, which might be due to the use of different approaches. The choice of technique influences the involved area and block duration. To investigate the actual analgesic effects of TAP blocks, we unified the nomenclature system and clarified the definition of each technique. Although a single-shot TAP block is limited in duration, it is still the candidate of the analgesic standard for abdominal wall surgery because the use of the catheter technique and liposomal bupivacaine may overcome this limitation. Summary Ultrasound-guided TAP blocks are commonly used. With the unified nomenclature and the development of catheter technique and/or liposomal local anesthetics, TAP blocks can be applied more appropriately to achieve better pain control.
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Brull R, Hadzic A, Reina MA, Barrington MJ. Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade. Reg Anesth Pain Med 2015; 40:479-90. [PMID: 25974275 DOI: 10.1097/aap.0000000000000125] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This review synthesizes anatomical, anesthetic, surgical, and patient factors that may contribute to neurologic complications associated with peripheral nerve blockade. Peripheral nerves have anatomical features unique to a given location that may influence risk of injury. Peripheral nerve blockade-related peripheral nerve injury (PNI) is most severe with intrafascicular injection. Surgery and its associated requirements such as positioning and tourniquet have specific risks. Patients with preexisting neuropathy may be at an increased risk of postoperative neurologic dysfunction. Distinguishing potential causes of PNI require clinical assessment and investigation; a definitive diagnosis, however, is not always possible. Fortunately, most postoperative neurologic dysfunction appears to resolve with time, and the incidence of serious long-term nerve injury directly attributable to peripheral nerve blockade is relatively uncommon. Nonetheless, despite the use of ultrasound guidance, the risk of block-related PNI remains unchanged. WHAT'S NEW Since the 2008 Practice Advisory, new information has been published, furthering our understanding of the microanatomy of peripheral nerves, mechanisms of peripheral nerve injection injury, toxicity of local anesthetics, the etiology of and monitoring methods, and technologies that may decrease the risk of nerve block-related peripheral nerve injury.
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Affiliation(s)
- Richard Brull
- From the *Departments of Anesthesia, Toronto Western Hospital, University Health Network, and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; †Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, St Luke's and Roosevelt Hospitals, New York, NY; ‡School of Medicine, CEU San Pablo University, and Madrid Montepríncipe University Hospital, Madrid, Spain; and §Department of Anaesthesia, St Vincent's Hospital; Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
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