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Zhou A, Wang Y, Cheng Y, He M, Duan Y, Qin D, Jiang M. Single injection technique with ultrasound-guided superficial cervical fascia block combined with brachial plexus block in clavicular surgery: a prospective randomized comparative trial. BMC Anesthesiol 2023; 23:365. [PMID: 37936081 PMCID: PMC10629117 DOI: 10.1186/s12871-023-02333-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND To investigate the effects of a single injection technique with ultrasound-guided superficial cervical fascia block combined with brachial plexus block in clavicular surgery. METHODS Forty patients, 25 males and 15 females, aged 18-85 years with ASA class I or II underwent unilateral clavicular fracture internal fixation. The patients were randomly divided into a superficial cervical plexus block group (group S, n = 20) and a superficial cervical fascia block group (group F, n = 20). First, the brachial plexus of the intermuscular sulcus of all patients was blocked with an ultrasound-guided injection of one injection with 15ml 0.33% ropivacaine 15ml in both groups. Second, the superficial cervical plexus was blocked by another injection of 5-8ml 0.33% ropivacaine in group S, and the superficial cervical fascia was blocked by an injection with 5-8ml 0.33% ropivacaine in Group F. We evaluated operation time, onset time of anaesthesia, effective time and the grades of nerve block effect in the two groups. Additionally, we evaluated the incidences of local anaesthetic poisoning, hoarseness, dyspnoea, and postoperative nausea and vomiting, and the number of patients requiring remedial analgesia within 24 h. Repeated measurements were analysed by repeated data analysis of variance, and count data were compared by the χ2 test. A P value < 0.05 was considered statistically significant. RESULTS The operation time and onset time in Group F were significantly shorter than those in group S (P < 0.05); the effect of intraoperative block was better than that in group S (P < 0.05), and the effective time was significantly longer in group F than in group S (P < 0.05). However, no severe case of dyspnoea, local anaesthetic poisoning or hoarseness after anaesthesia occurred in either of two groups. There was no significant difference in the rate of postoperative salvage analgesia or that of postoperative nausea and vomiting between the two groups. CONCLUSIONS The application of the single injection technique with ultrasound-guided superficial cervical fascia block combined with brachial plexus block in clavicular surgery is beneficial because it shortens the operation time, has a faster onset, produces a more effective block and prolongs the longer analgesia time. TRIAL REGISTRATION Chinese Clinical Trial Registry- ChiCTR2200064642(13/10/2022).
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Affiliation(s)
- Anneng Zhou
- Department of Anesthesiology, Chongqing Wansheng Economic and Technological Development Zone People's Hospital, No. 43 Wandong North Road, Chongqing, People's Republic of China
| | - Ying Wang
- Department of Anesthesiology, Chongqing Wansheng Economic and Technological Development Zone People's Hospital, No. 43 Wandong North Road, Chongqing, People's Republic of China
| | - Yonghong Cheng
- Department of Orthopaedics, Chongqing Wansheng Economic and Technological Development Zone People's Hospital, Chongqing, People's Republic of China
| | - Mei He
- Department of Anesthesiology, Chongqing Wansheng Economic and Technological Development Zone People's Hospital, No. 43 Wandong North Road, Chongqing, People's Republic of China
| | - Yongting Duan
- Department of Anesthesiology, Chongqing Wansheng Economic and Technological Development Zone People's Hospital, No. 43 Wandong North Road, Chongqing, People's Republic of China
| | - Dongfang Qin
- Department of Anesthesiology, Chongqing Wansheng Economic and Technological Development Zone People's Hospital, No. 43 Wandong North Road, Chongqing, People's Republic of China
| | - Mengbi Jiang
- Institute of Anesthesiology and Critical Care Medicine, Three Gorges University & Yichang Central People's Hospital, No. 183 Yiling Avenue, Wujiagang District, Yichang, Hubei Province, 443003, People's Republic of China.
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Hu CY, Huang YZ, Tsai ST, Wang PK. Successful Ultrasound-Guided Superficial Cervical Plexus Block Treatment for Head and Neck Pain with an Unusually Delayed Onset Following Ventriculoperitoneal Shunt: A Case Report. Medicina (Kaunas) 2023; 59:1909. [PMID: 38003958 PMCID: PMC10673198 DOI: 10.3390/medicina59111909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Ventriculoperitoneal (VP) shunt placement is the most common treatment for cerebrospinal fluid diversion. Head and neck pain occurring after a long period following VP shunt insertion is rarely reported. Here, we present a rare case of head and neck pain occurring 2 years after surgery due to irritation of the superficial cervical plexus by the VP shunt. Case Description: A 46-year-old female patient received VP shunt placement surgery. Two years after the surgery, she experienced a left temporal headache with neck pain on the left side, which extended to the left para-auricular and fascial region. Ultrasound (US) scanning revealed that the VP shunt passed within the superficial cervical fascia and through the left sternocleidomastoid muscle (SCM). Additionally, friction of the branches of the superficial cervical plexus and of the greater auricular and lesser occipital nerves caused by the VP shunt was found underneath the lateral border of the SCM. Subsequently, the blocking and hydro-release of the left superficial cervical plexus were performed. After four series of treatments, the patient's head and neck pain vanished, and the frequency of the headaches was substantially reduced. The patient was regularly followed-up in the outpatient department of neurosurgery. Conclusions: Head and neck pain caused by the malpositioning of a VP shunt catheter with an unusually delayed onset is a rarely reported complication and could be easily neglected. Patients with head and neck pain following VP shunt insertion should be checked using US scanning to identify the potential origin of the pain and receive adequate treatments. Intraoperative US-guided tunnelling is suggested to avoid the malpositioning of the VP shunt catheter.
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Affiliation(s)
- Ching-Yuan Hu
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (C.-Y.H.); (Y.-Z.H.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan;
| | - Ying-Zhen Huang
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (C.-Y.H.); (Y.-Z.H.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan;
| | - Sheng-Tzung Tsai
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan;
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
| | - Po-Kai Wang
- Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (C.-Y.H.); (Y.-Z.H.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan;
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Kilbasanli S, Kaçmaz M. General anesthesia versus combined interscalene nerve/superficial cervical plexus block in arthroscopic rotator cuff repair: A randomized prospective control trial. Medicine (Baltimore) 2023; 102:e35522. [PMID: 37861492 PMCID: PMC10589582 DOI: 10.1097/md.0000000000035522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND In this study, interscalene brachial plexus block (ISB) with superficial cervical plexus block added and general anesthesia (GA) application were evaluated in terms of intraoperative hemodynamics, operative time and postoperative analgesia need in patients who underwent rotator cuff tear repair. METHODS 70 patients aged between 18 and 75 years were included in this prospective study. Arthroscopic rotator cuff tear repair surgery was performed in all patients. The patients were randomized into 2 groups, namely Group ISB who received a combination of superficial cervical plexus block added to the Interscalene Nerve Block, and Group GA, for those who received GA. Duration of operation, waiting times, intraoperative hemodynamic data, postoperative visual analog scale (VAS), analgesic requirement, as well as patient and surgeon satisfaction levels, were compared between the 2 groups. RESULTS While VAS values at the post-anesthesia care unit were lower in ISB group at 2 and 24 hours (P < .05), there was no significant difference between VAS values measured at 6th and 12th hours (P ≥ .05). In the GA group, postoperative morphine and diclofenac consumption was higher, and rescue analgesia was needed earlier (P < .05). The hospital stay was shorter (P < .05), and surgeon and patient satisfaction were higher in the ISB group (P < .05). CONCLUSION SUBSECTIONS In rotator cuff tear repair anesthesia, ISB with superficial cervical plexus block provides adequate intraoperative anesthesia, low postoperative VAS level, reduced and deferred consumption of opioids and nonsteroidal anti-inflammatory drugs, higher patient and surgeon satisfaction and early discharge.
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Affiliation(s)
- Seval Kilbasanli
- Department of Anesthesiology, Training and Research Hospital, Nigde, Turkey
| | - Mustafa Kaçmaz
- Department of Anesthesiology, Ömer Halisdemir University Faculty of Medicine, Nigde, Turkey
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Yamaguchi A, Kojima Y, Hirabayashi K. Ultrasound-Guided Maxillary Nerve Block and Superficial Cervical Plexus Block During Surgery for Maxillary Malignancy: A Case Report. Anesth Prog 2023; 70:88-90. [PMID: 37379090 PMCID: PMC10328195 DOI: 10.2344/anpr-70-02-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/13/2023] [Indexed: 06/29/2023] Open
Abstract
We report a case of ultrasound-guided craniocervical nerve blocks performed with ropivacaine for perioperative local/regional anesthesia in a patient who underwent right partial maxillary resection and neck dissection under general anesthesia. The patient was an 85-year-old woman with multiple medical comorbidities in whom analgesia using nonsteroidal anti-inflammatory drugs and opioids was expected to increase the risk of postoperative complications. Bilateral ultrasound-guided maxillary (V2) nerve blocks and a right superficial cervical plexus block were performed, which provided adequate perioperative anesthesia and avoided postoperative complications. The use of ultrasound-guided craniocervical nerve blocks with ropivacaine can be an effective approach for providing prolonged perioperative local anesthesia and analgesia, minimizing the need for other potentially problematic analgesics.
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Affiliation(s)
- Atsuki Yamaguchi
- Department of Dental and Oral Surgery, Asahi General Hospital, Chiba, Japan
| | - Yuki Kojima
- Department of Anesthesiology, Asahi General Hospital, Chiba, Japan
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Niraj G. Intermediate cervical plexus block in the management of treatment resistant chronic cluster headache following whiplash trauma in three patients: a case series. Scand J Pain 2023; 23:208-212. [PMID: 35977523 DOI: 10.1515/sjpain-2022-0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/26/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Cluster headaches are an intensely painful and debilitating headache disorder. Conventional management includes abortive and preventative agents. A fifth of patients with chronic cluster headaches can be refractory to conventional treatment. Cluster headache can develop following whiplash trauma to the head and neck. CASE PRESENTATION Three patients were referred to a tertiary pain medicine unit in a university teaching hospital with treatment-resistant chronic cluster headache. They were treated with a novel intervention namely, ultrasound-guided intermediate cervical plexus block with depot methylprednisolone. Patient one reported chronic cluster headache for three years. Patient two reported episodic cluster headache that appeared to be evolving into chronic cluster headache. Patient three reported bilateral cluster headache following a motor vehicle accident. Intermediate cervical plexus block provided significant and durable relief in three patients with treatment resistant chronic cluster headache. CONCLUSIONS The novel intervention may have played a role in aborting and preventing chronic cluster headaches.
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Affiliation(s)
- G Niraj
- Consultant in Anaesthesia & Pain Medicine, Clinical Research Unit of Pain Medicine, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW, UK
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Di Pietro S, Caracciolo E, Barcella B, Perlini S. Superficial cervical plexus block in Emergency Departments: rationale for its use in incision and drainage of neck skin abscesses. Intern Emerg Med 2022; 17:1533-1536. [PMID: 35670893 DOI: 10.1007/s11739-022-02992-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/12/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Santi Di Pietro
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, P.le Golgi, 19 27100, Pavia, Italy
| | - Emilio Caracciolo
- Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, 19 27100, P.le GolgiPavia, Italy
| | - Bruno Barcella
- Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, 19 27100, P.le GolgiPavia, Italy.
| | - Stefano Perlini
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, P.le Golgi, 19 27100, Pavia, Italy
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7
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Yılmaz ZÇ, Güler N, Noyan A. Superficial cervical plexus block on pain control in patients with temporomandibular joint internal derangement with headache: a retrospective cohort study. Quintessence Int 2022; 53:512-521. [PMID: 35274514 DOI: 10.3290/j.qi.b2793235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Temporomandibular disorders (TMDs) are a group of disorders with varied pathophysiology and clinical manifestations. Masticatory and cervical motor systems have a functional relationship. Superficial cervical muscles have greater hyperactivity in myogenous and mixed TMDs than in healthy individuals, demonstrating an abnormal pattern of contraction. This study aimed to demonstrate the effects of superficial cervical plexus block (SCPB) anesthesia during arthrocentesis in patients with temporomandibular joint (TMJ) internal derangement and headache. METHOD AND MATERIALS This retrospective cohort study included 2 men and 23 women with cervicogenic headache and TMJ internal derangement treated by arthrocentesis, and 40 TMJs with established cervicogenic headaches. The average follow-up period was 9.36 ± 2.679 months. TMJ and muscle pain during mastication, maximum and non-assisted mouth opening, and lateral excursion were recorded. Pain and dysfunction were determined using the visual analog scale. Patients were monitored before, during, and after arthrocentesis while inducing SCPB anesthesia, and vital findings were recorded. In addition, skin surface temperature was measured. RESULTS Patients experienced a significant increase in their clinical values. Changes in non-assisted mouth opening (mean from 29.65 ± 6.31 to 33.3 ± 5.21 mm) (P < .05), assisted mouth opening (mean from 38.98 ± 7.62 to 43.35 ± 6.17 mm), right excursions (mean from 7.28 ± 2.08 to 9.13 ± 1.86 mm), and left excursions (mean from 7.48 ± 1.71 to 8.90 ± 1.82 mm) were statistically significant (P < .05). Patients were relieved after SCPB, resulting in decreased pain and hemodynamic values. Increase in mean temperature after SCPB was statistically significant (P = .002, P < .05). CONCLUSION This study presents a straightforward novel protocol, clinically efficient for arthrocentesis on pain control in patients with TMJ internal derangement and cervicogenic headache.
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Takemura N, Miyashita T, Baba Y. Anesthetic Management of a Patient Undergoing Cochlear Implantation With Superficial Cervical Plexus Block and Sedation: A Case Report. A A Pract 2022; 16:e01555. [PMID: 35020618 DOI: 10.1213/xaa.0000000000001555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Avoidance of general anesthesia and endotracheal intubation has been shown to reduce respiratory complications in patients with severe lung disease. We describe the case of a 75-year-old patient with chronic obstructive pulmonary disease (COPD) who underwent cochlear implantation managed with nerve block and sedation. A superficial cervical plexus block (SCPB) was performed with 1% mepivacaine before surgery. A small amount of intravenous analgesic and sedative was administered. The patient experienced only slight pain during surgery. A SCPB had a good analgesic effect on the posterior auricle. Cochlear implantation in patients with COPD can be performed using a SCPB and sedation.
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Affiliation(s)
- Natsuki Takemura
- From the Department of Anesthesiology, International University of Health and Welfare, Mita Hospital
| | - Tetsuya Miyashita
- From the Department of Anesthesiology, International University of Health and Welfare, Mita Hospital
| | - Yasuko Baba
- From the Department of Anesthesiology, International University of Health and Welfare, Mita Hospital
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, International University of Health and Welfare
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Uhlig C, Vicent O, Spieth S, Ludwig S, Reeps C, Heller AR, Thea K, Spieth PM, Rössel T. Influence of Anatomic Conditions on Efficacy and Safety of Combined Intermediate Cervical Plexus Block and Perivascular Infiltration of Internal Carotid Artery in Carotid Endarterectomy: A Prospective Observational Trial. Ultrasound Med Biol 2021; 47:2890-2902. [PMID: 34325958 DOI: 10.1016/j.ultrasmedbio.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/22/2021] [Accepted: 05/11/2021] [Indexed: 06/13/2023]
Abstract
Ultrasound-guided intermediate cervical plexus blockade with perivascular infiltration of the carotid artery bifurcation perivacular block (PVB) is a reliable technique for regional anesthesia in carotid endarterectomy (CEA). We investigated the effect of the carotid bifurcation level (CBL) on PVB efficacy and safety in patients undergoing CEA. This prospective observational cohort study included 447 consecutive CEA patients who received PVB over a 6-y period. Vascular and neurologic puncture-related complications were recorded. The CBL was localized at the low level (C4 and C5 vertebra, low-level [LL] group) in 381 (85.2%) patients and at the high level (C2 and C3 vertebra, high-level [HL] group) in 66 (14.8%) patients. Local anesthetic supplementation by surgeons was necessary in 64 (14.3%) patients in the LL group and 38 (59.4%) patients in the HL group (p < 0.001) and was associated with a higher rate of central neurologic complications in the HL group (p = 0.031). Therefore, the efficacy of the PVB may be influenced by the CBL.
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Affiliation(s)
- Christopher Uhlig
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Oliver Vicent
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Stephanie Spieth
- Department of Radiology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ludwig
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Reeps
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Axel R Heller
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; Department of Anesthesiology and Surgical Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany
| | - Koch Thea
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Peter Markus Spieth
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Thomas Rössel
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
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Xing J, Wu R, Liang L, Fang H, Chen L, Luo C. Comparison of the Analgesic Effects of Intravenous Infusion of Dexmedetomidine Versus Bilateral Superficial Cervical Plexus Block After Thyroidectomy: A Randomized Controlled Trial. Clin J Pain 2021; 37:623-628. [PMID: 34155159 DOI: 10.1097/ajp.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Dexmedetomidine (DEX) is widely used in clinical practice because of its safety and effectiveness. Superficial cervical plexus block (SCPB) can reduce pain in thyroid surgery. The objective of this study was to investigated whether intravenous DEX has an equivalent analgesic effect and patients' satisfaction to SCPB for thyroid surgery. MATERIALS AND METHODS Ninety patients who had been scheduled for thyroidectomy under general anesthesia with endotracheal intubation were randomly divided into 3 groups. Group D: DEX was administered intravenously at an initial dose of 1 µg/kg over 10 minutes; then induction and endotracheal intubation performed, and then a continuous intravenous infusion of DEX was administered at a rate of 0.4 μg/kg/h until 30 minutes before the end of surgery. Group B: ultrasound-guided bilateral SCPB was performed, with 10 mL of 0.375% ropivacaine injected on each side. Group C: intravenous saline was administered at the same rate and dose as in group D. Patients' perioperative status, visual analog scale scores, complications and patients' satisfaction were recorded. RESULTS The pain at rest at 1 hour after extubation and the movement-evoked pain within 24 hours after extubation were significantly lower in groups D and B than in group C. Patients' satisfaction was significantly higher in groups D and B than in group C. There was no difference in pain at rest, movement-evoked pain and patients' satisfaction between group D and B. CONCLUSIONS Perioperative intravenous infusion of DEX can effectively reduce wound pain after thyroidectomy, and the analgesic effect is equivalent to that of bilateral SCPB.
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Affiliation(s)
- Jibin Xing
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Ranliang Wu
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Ling Liang
- Department of Anesthesiology, The People's Hospital of Gaoming, Foshan, China
| | - Hongyi Fang
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Liubing Chen
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Chenfang Luo
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou
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Naja AS, Madi N, Tfayli Y, Ziade F, Haber G, Kanawati S, Naja Z. Deep Cervical Plexus Block for Neck and Shoulder Pain Due to Myofascial Pain: A Randomized Clinical Trial. Clin J Pain 2021; 37:133-139. [PMID: 33273276 DOI: 10.1097/ajp.0000000000000904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Myofascial pain is one of the most common causes of regional pain with no definitive treatment. This randomized clinical trial was conducted to assess the efficacy of deep cervical plexus block versus placebo injection (sham block) for the treatment of myofascial neck and shoulder pain in terms of analgesic consumption and pain during a follow-up period of 2 weeks after the block. MATERIALS AND METHODS Patients were randomly divided into 2 groups. Group I (block) received deep cervical plexus block and group II (placebo) received normal saline. A total of 66 patients were included in the study, 34 patients in the block group and 32 patients in the placebo group. RESULTS Two weeks after the intervention, the average pain duration was significantly lower in the block group: 1.38±1.39 versus 5.25±1.72 for the block and placebo groups, respectively (P<0.0001). Pain intensity was significantly less in the block group such that 2.9% of patients in the block group had severe pain compared with 53.1% of patients in the placebo group (P<0.0001). Two weeks after receiving the block, the mean opioid consumption calculated as tramadol equivalent was 21.1±44.2 mg compared with 166.1±118.8 mg for the block and placebo groups, respectively. Multivariate analysis showed that patients with a longer history of pain had a higher pain score after 2 weeks. The possibility of recovery is affected by pain duration as patients with a history of chronic pain were least affected by the block. DISCUSSION This technique could be an alternative to pharmacological and other nonpharmacological treatments for myofascial pain.
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Affiliation(s)
- Ahmad S Naja
- Orthopedic Division, American University of Beirut Medical Center
| | - Naji Madi
- Orthopedic Department, Duke University Medical Center, Durham, NC
| | - Yehia Tfayli
- Orthopedic Division, American University of Beirut Medical Center
| | - Fouad Ziade
- Faculty of Public Health, Lebanese University
| | - Georges Haber
- Orthopedic Division, Mount Lebanon Hospital, Hazmiyeh, Lebanon
| | - Saleh Kanawati
- Anesthesia and Pain Management Department, Makassed General Hospital, Beirut
| | - Zoher Naja
- Anesthesia and Pain Management Department, Makassed General Hospital, Beirut
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Peng K, Zeng M, Dong J, Yan X, Wang D, Li S, Peng Y. Ultrasound-guided superficial cervical plexus block for analgesia in patients undergoing craniotomy via suboccipital retrosigmoid approach: study protocol of a randomised controlled trial. BMJ Open 2020; 10:e034003. [PMID: 32029493 PMCID: PMC7044881 DOI: 10.1136/bmjopen-2019-034003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Scalp nerve block has been proven to be an alternative choice to opioids in multimodal analgesia. However, for the infratentorial space-occupying craniotomy, especially the suboccipital retrosigmoid craniotomy, scalp nerve block is insufficient. METHODS AND ANALYSIS The study is a prospective, single-centre, randomised, paralleled-group controlled trial. Patients scheduled to receive elective suboccipital retrosigmoid craniotomy will be randomly assigned to the superficial cervical plexus block group or the control group. After anaesthesia induction, superficial cervical plexus nerve block will be performed under the guidance of ultrasound. The primary outcome is the cumulative consumption of sufentanil by the patient-controlled intravenous analgesia pump within 24 hours after surgery. Secondary outcomes include the cumulative consumption of sufentanil at other four time points and numerical rating scale pain severity score. ETHICS AND DISSEMINATION The protocol (version number: 2.0, 10 April 2019) has been approved by the Ethics Review Committee of China Registered Clinical Trials (Ethics Review No. ChiECRCT-20190047). The findings of this study will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER NCT04036812.
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Affiliation(s)
- Kun Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Min Zeng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jia Dong
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiang Yan
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dexiang Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shu Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuming Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Fugelli CG, Westlye ET, Ersdal H, Strand K, Bjørshol C. Combined Interscalene Brachial Plexus and Superficial Cervical Plexus Nerve Block for Midshaft Clavicle Surgery: A Case Series. AANA J 2019; 87:374-378. [PMID: 31612842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Clavicle fractures are common, and there has been a recent increase in surgical fixation of displaced fractures. General anesthesia is traditionally preferred for these operations because regional anesthesia can be challenging. This is partly due to a complex nerve innervation in this region, which makes the correct choice of nerve block difficult. The objective of this study was to evaluate the efficacy of a combined interscalene brachial plexus block and superficial cervical plexus peripheral nerve block as anesthesia for clavicle surgical procedures. Ten midshaft clavicle fractures were surgically repaired using a combination of an ultrasound-guided interscalene brachial plexus block and a superficial cervical plexus block as the primary anesthetic. All patients underwent surgery successfully using regional anesthesia with light sedation, without the need for rescue opioids or rescue local anesthesia. No adverse events were recorded. This case series describes a successful peripheral nerve block combination that can be used for clavicle surgery.
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Affiliation(s)
- Caroline G Fugelli
- is a senior consultant and chief of the Orthopedic/Neurosurgical Department of Anesthesiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Hege Ersdal
- is a senior consultant in the Department of Anesthesiology, Stavanger University Hospital
| | - Kristian Strand
- is a senior consultant and chief of the Intensive Care Unit, Department of Intensive Care Medicine, Stavanger University Hospital
| | - Conrad Bjørshol
- is a senior consultant in the Department of Anesthesiology and project manager at The Regional Centre for Emergency Medical Research and Development (RAKOS), Prehospital Medicine Clinic, Stavanger University Hospital. Dr Bjørshol also is an associate professor in the Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Pinto LDC, Silva CHRD, Gonçalves PMSE, Valadares RJ. Supraclavicular nerve and superior trunk block for surgical treatment of clavicle fracture in a patient with Steinert's disease – Case report. Brazilian Journal of Anesthesiology (English Edition) 2019. [PMID: 30301614 PMCID: PMC9391788 DOI: 10.1016/j.bjane.2018.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background and objectives Ultrasound-guided upper limb blocks may provide great benefits to patients with serious diseases. Patients with Steinert's disease have muscle weakness and risk of triggering myotony or malignant hyperthermia due to the use of anesthetic agents and surgical stress. The objective of this report was to demonstrate a viable alternative for clavicle fracture surgery with upper trunk and supraclavicular nerve block, thus reducing the spread of local anesthetic to the phrenic nerve in a patient with muscular dystrophy. Case report A 53-year-old male patient with Steinert's disease, associated with dyspnea, hoarseness and dysphagia, referred to the surgical theater for osteosynthesis of clavicle fracture. Upper limb (1 mL 0.75% ropivacaine) and supraclavicular nerve block (1 mL 0.75% ropivacaine in each branch) were combined with venous anesthesia with propofol under laryngeal mask (infusion pump target of 4 mcg.mL−1). Upon awakening, the patient had no pain or respiratory complaints. He was transferred to the ICU for immediate postoperative follow-up with discharge from this unit after 24 h without complications. Conclusions The superior trunk and cervical plexus block associated with venous anesthesia under laryngeal mask, without the use of opioids, proved to be adequate in the case of a patient with clavicle fracture and Steinert's disease. With the use of ultrasonography in regional anesthesia it is possible to perform increasingly selective blocks, thus allowing greater security for the anesthetic-surgical procedure and lower morbidity for the patient.
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Affiliation(s)
- Leonardo Diniz Correa Pinto
- Hospital Sírio-Libanês, Pós-Graduação em Anestesia Regional, São Paulo, SP, Brasil; Unimed BH, Hospital Odilon Behrens, Belo Horizonte, MG, Brasil; Hospital Santa Rita, Contagem, MG, Brasil.
| | | | | | - Roberto José Valadares
- Hospital Unimed BH, Unidade Contorno, Belo Horizonte, MG, Brasil; Hospital Semper, Belo Horizonte, MG, Brasil; Hospital Alberto Cavalcanti (Rede Fhemig), Belo Horizonte, MG, Brasil
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Trabelsi W, Ben Gabsia A, Lebbi A, Sammoud W, Labbène I, Ferjani M. Suprascapular block associated with supraclavicular block: An alternative to isolated interscalene block for analgesia in shoulder instability surgery? Orthop Traumatol Surg Res 2017; 103:77-83. [PMID: 27916737 DOI: 10.1016/j.otsr.2016.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 10/12/2016] [Accepted: 10/27/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Interscalene brachial plexus block (ISB) is the gold standard for postoperative pain management in shoulder surgery. However, this technique has side effects and potentially serious complications. The aim of this study was to compare the combinations of ultrasound-guided suprascapular (SSB) associated with supraclavicular nerve block (SCB) and ultrasound-guided ISB for postoperative analgesia after shoulder instability surgery. METHODS Sixty ASA physical status I-II patients scheduled to undergo shoulder instability surgery were included. Two groups: (i) the SSB+SCB group (n=30) in which the patients received a combination of US-guided SSB (15mL of bupivacaine 0.25%) and US-guided SCB (15mL of bupivacaine 0.25%) and (ii) the ISB group (n=30) in which the patients received US-guided ISB with 30mL of bupivacaine 0.25%. General anesthesia was administered to all patients. During the first 24h, the variables assessed were time to administer the anesthesia, duration of the analgesia, onset and duration of motor and sensory blockade, opioid consumption, cardiovascular stability, complications, and patient satisfaction. RESULTS Anesthesia induction took more time for the SSB+SCB group than for the ISB group. However, the onset time of motor and sensory blockade was similar in the two groups. Statistical analysis of the visual analog postoperative pain scoring at H0, H6, H12, and H24 showed nonsignificant differences between the groups. Analgesia, the first request for morphine, and total morphine consumption during the first 24h was similar in both groups. No complication was recorded in the SSB+SCB group. However, phrenic nerve block occurred in all patients in the ISB group. CONCLUSION US-guided SCB combined with US-guided SSB was as effective as ISB for postoperative analgesia after shoulder instability surgery without decreasing potential side effects. TRIAL REGISTRATION NCT identifier: NCT02397330.
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Affiliation(s)
- W Trabelsi
- Service d'anesthésie-réanimation, hôpital militaire de Gabès, 6000 Gabès, Tunisia.
| | - A Ben Gabsia
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
| | - A Lebbi
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
| | - W Sammoud
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
| | - I Labbène
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
| | - M Ferjani
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
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Matsunami S, Komasawa N, Fujiwara S, Fujitate Y, Soen M, Minami T. [Anesthetic Management Using Frontal Nerve, Greater Occipital Nerve, and Superficial Cervical Plexus Block for Posterior Cervical Spinal Fusion in a Patient with Athetoid Cerebral Palsy]. Masui 2015; 64:549-551. [PMID: 26422967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Here, we report successful anesthetic management of posterior cervical spinal fusion utilizing block of the frontal nerve, the greater occipital nerve, and the superficial cervical plexus in a patient with athetoid cerebral palsy. A 69-year-old woman (height 157 cm; weight 33 kg) with athetoid cerebral palsy was scheduled to undergo posterior cervical spinal fusion for cervical spondylotic myelopathy. After induction of general anesthesia, we performed tracheal intubation using the Pentax-AWS Airwayscope with a thin Intlock. After tracheal intubation, we used ropivacaine for the frontal nerve, greater occipital nerve, and superficial cervical plexus block. Anesthetic maintenance was performed with total intravenous anesthesia utilizing propofol and remifentanil. Continuous administration of dexmedetomidine was started during operation. Following surgery, smooth spontaneous ventilation was observed following uneventful extubation. No significant pain and no athetoid movement were observed under continuous administration of dexmedetomidine.
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MEEK EM. Cervical plexus block, brachial plexus block and stellate ganglion block; techniques utilizing soft tissue as landmarks. Miss Doct 1949; 27:21-23. [PMID: 18130855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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