Journal ArticleDOI
Paresthesiae or No Paresthesiae? Nerve Lesions after Axillary Blocks
D. Selander,S. Edshage,T. Wolff +2 more
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TLDR
Two groups of patients who underwent hand surgery with an axillary block were followed to test the hypothesis that actively seeking paresthesiae when performing a peripheral nerve block may increase the risk of post‐anesthetic neurological sequelae.Abstract:
Seeking paresthesiae when performing a peripheral nerve block may increase the risk of post-anesthetic neurological sequelae. To test this hypothesis, we prospec-tively followed two groups of patients who underwent hand surgery with an axillary block. In one group, the axillary plexus was located by actively seeking paresthesiae; in the other, pulsations of the axillary artery indicated an adequate position of the injection needle. Mepivacaine 10 mg/ml, with or without adrenaline, was used. The study included 533 patients, 290 in the paresthesia group and 243 in the artery group.
Although unintentional, paresthesiae were elicited in 40% of patients in the artery group. Postanesthetic nerve lesions were seen in ten patients, eight in the paresthesia group and two in the artery group, all of whom had been blocked by mepivacaine with adrenaline. Symptoms varied between light paresthesiae lasting a few weeks, and severe paresthesiae, ache and paresis lasting more than 1 year. The etiology suspected was needle and perhaps injection trauma to the nerves during blocking. We conclude that whenever possible nerve blocks should be performed without searching for paresthesiae.read more
Citations
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Journal ArticleDOI
Neurological complications after regional anesthesia: contemporary estimates of risk.
TL;DR: It is suggested that the rate of neurological complications after central nerve blockade is <4:10,000, or 0.04%.The rate of neuropathy after PNB is <3:100, or 3%.
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Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study.
TL;DR: In case of persistent paresthesia, dysesthesia, or pain not related to surgery after ISB, sulcus ulnaris syndrome, carpal tunnel syndrome, or complex regional pain syndrome should be excluded since specific treatment may be required.
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Nerve Stimulator and Multiple Injection Technique for Upper and Lower Limb Blockade: Failure Rate, Patient Acceptance, and Neurologic Complications
TL;DR: To evaluate the failure rate, patient acceptance, effective volumes of local anesthetic solution, and incidence of neurologic complications after peripheral nerve block performed using the multiple injection technique with a nerve stimulator, 3996 patients undergoing combine are prospectively studied.
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Lower extremity regional anesthesia: essentials of our current understanding.
TL;DR: The current review article strives to summarize the pertinent anatomy of the lumbar and sacral plexuses, discuss the optimal approaches and techniques for lower limb regional anesthesia, and identify informational gaps pertaining to outcomes, which warrant further investigation.
Journal ArticleDOI
ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine.
Joseph M. Neal,Joseph M. Neal,Christopher M. Bernards,Christopher M. Bernards,Admir Hadzic,James R. Hebl,Quinn H. Hogan,Terese T. Horlocker,Lorri A. Lee,James P. Rathmell,Eric J. Sorenson,Santhanam Suresh,Denise J. Wedel +12 more
TL;DR: The current Practice Advisory offers recommendations to aid in the understanding and potential limitation of neurologic complications that may arise during the practice of regional anesthesia and pain medicine.
References
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Journal ArticleDOI
Peripheral nerve injury due to injection needles used for regional anesthesia. An experimental study of the acute effects of needle point trauma.
TL;DR: Results show that a 45°‐beveled needle less frequently produces fascicular damage and should therefore be recommended for use in clinical anesthesia, and it is concluded that paresthesiae, when necessary, should be elicited gently, and that intraneural injections should be avoided.
Journal ArticleDOI
Local anesthetics: importance of mode of application, concentration and adrenaline for the appearance of nerve lesions. An experimental study of axonal degeneration and barrier damage after intrafascicular injection or topical application of bupivacaine (Marcain).
TL;DR: It is concluded that intraneural injections should be avoided and that plain bupivacaine solutions should be routinely used.
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Longitudinal Spread of Intraneurally Injected Local Anesthetics: An Experimental Study of the Initial Neural Distribution Following Intraneural Injections
D. Selander,J. Sjöstrand +1 more
TL;DR: To analyze the pathway of such a spread, a radioactive local anesthetic mixed with a fluorescent dye was injected into different compartments of the rabbit sciatic nerve, and the early distribution of these tracers was studied by scintillation counting and fluorescence microscopy.
Journal ArticleDOI
Catheter technique in axillary plexus block. Presentation of a new method.
TL;DR: A flexible, disposable intravenous catheter can be introduced into the neurovascular sheath in the axilla and used for injection of local anesthetic solution to block the axillary brachial plexus.