Exparel to get nerve block indication

[BLADEMDA]

Original Article

Anatomical Variation Leads to Phrenic Nerve Palsy after Supraclavicular Block.
A Gupta, V Dhulkhed, D Divekar, A Gupta


http://ispub.com/IJPSP/7/1/8875#

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[BLADEMDA]

Anatomical Variation Leads to Phrenic Nerve Palsy after Supraclavicular Block.
A Gupta, V Dhulkhed, D Divekar, A Gupta


http://ispub.com/IJPSP/7/1/8875#[/QUOTE]



Advanced age, low baseline PEF and large local anesthetic volume are significant predictors of phrenic nerve paresis after supraclavicular block. Due to the small sample size of this pilot study, the effect of each potential predictor on the incidence of diaphragmatic paresis is still uncertain. Match study design will be warranted to evaluate the effect of each potential factor on phrenic nerve paresis in the future.
http://www.asra.com/display_spring_2010.php?id=319

 

[BLADEMDA]

A patient with end stage COPD and a fractured humerus. What technique would you choose?
Abstract Type: Medically Challenging Case

Nisha Malhotra MD1 ; Shawn Kunnavatana MD2; Ludwig Lin MD3
UCSD1 ; Stanford2; Stanford3


http://www.asra.com/display_spring_2011.php?id=182

I'm a huge fan of the Infraclavicular block technique for elderly patients. I've used it with great success but NEVER thought it would cover proximal humerus fractures. Perhaps, an ICB with a Suprascapular block is the ticket in the highest risk patients?

 

[BuzzPhreed]

Anatomical variation? C'mon, Blade. Any one of us could case report our way to just about any complication if we wanted to.

 

[BLADEMDA]

Acta Anaesthesiol Scand. 2013 Jul;57(6):761-6. doi: 10.1111/aas.12109. Epub 2013 Mar 25.
Effects of age on minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block.
Pavičić Šarić J1, Vidjak V, Tomulić K, Zenko J.

Elderly patients only need 12 mls which is why I routinely use 15-18 mls in the high risk subgroup with excellent results.

http://www.ncbi.nlm.nih.gov/pubmed/23527790

 

[BLADEMDA]

DISCUSSION:
Our data indicate that a volume of 15ml of 1.5% mepivacaine results in similar quality of surgical anesthesia as a volume of 30ml of the same local anesthetic solution, when a triple injection technique with ultrasound guidance is utilized. At the same time, motor function was significantly more preserved in patients receiving the lower volume. Future research should evaluate whether, reducing the local anesthetic volume may also result in lower complication rate associated with supraclavicular nerve blocks.
'
http://www.asra.com/display_spring_2010.php?id=167

 

[Noyac]

DISCUSSION:
Our data indicate that a volume of 15ml of 1.5% mepivacaine results in similar quality of surgical anesthesia as a volume of 30ml of the same local anesthetic solution, when a triple injection technique with ultrasound guidance is utilized. At the same time, motor function was significantly more preserved in patients receiving the lower volume. Future research should evaluate whether, reducing the local anesthetic volume may also result in lower complication rate associated with supraclavicular nerve blocks.
'
http://www.asra.com/display_spring_2010.php?id=167

Isn't this intuitive already?

 

[BLADEMDA]

Isn't this intuitive already?

Buzz thinks his patients will NEVER get respiratory compromise post SCB. Buzz is wrong. I agree with doing a low ISB or high SCB for patients at risk for resp compromise but a reduction in local anesthetic volume should still be utilized and there is still a chance of postop respiratory problems.


http://www.ncbi.nlm.nih.gov/pubmed/19920426

Ultrasound-guided interscalene brachial plexus block performed at the level of root C7 using 10 mL of ropivacaine 0.75% reduces the incidence of hemidiaphragmatic paresis



http://www.ncbi.nlm.nih.gov/pubmed/19916254




Conclusions: Ultrasound-guided supraclavicular brachial plexus block, using 20 mL of 0.75% ropivacaine with the described technique, is not associated with hemidiaphragmatic paresis.

 

[BLADEMDA]

The only way to truly guarantee ZERO respiratory compromise for any individual patient is to avoid brachial plexus blocks above the clavicle. This means a Suprascapular nerve block plus an ICB under U/S would be an example of such a technique.

Buzz's concept that a low ISB/High SCB avoids phrenic nerve palsy completely is simply incorrect. Even a reduction in local anesthetic volume combined with a low ISB technique doesn't guarantee a zero percent incidence of phrenic nerve palsy.

http://www.ncbi.nlm.nih.gov/pubmed/19920426

13% of the patients in the low ISB plus low Volume group (10 mls) with U/S still had evidence of phrenic nerve blockade.

 

[Noyac]

I was talking more about the type of local used ( mepivicaine) and the volumes.

 

[Arch Guillotti]

I agree with Blade for the most part here. Anyways there is no way to match his search, copy and paste skills!

 

[lgher]

Although it sometimes takes time to filter through blade's posts, I feel they expose me to studies I haven't seen before and can use in discussion with academic anesthesiologist's on a day to day basis.