ABSTRACT
Abstract The regional techniques for axillary analgesia are well established. However, few studies have investigated surgical anesthesia. In this report, extensive debridement of axillary necrotizing fasciitis, including the posteromedial region of the right arm, performed under exclusive regional anesthesia in a patient with probable difficult airway is described. The procedure was accomplished under a Serratus Plane Block (SPB) and supraclavicular brachial plexus block, guided by ultrasound, and with venous sedation. We observed satisfactory anesthesia 15 minutes after the intervention, efficient intraoperative pain control and within the following 24 hours. Surgical axilla anesthesia is feasible with the described blocks.
Subject(s)
Humans , Brachial Plexus , Fasciitis, Necrotizing/surgery , Brachial Plexus Block/methods , Pain , Axilla , Ultrasonography, Interventional/methods , Debridement , Anesthetics, LocalABSTRACT
Abstract Background and objectives: YouTube, the most popular video-sharing website, contains a significant number of medical videos including brachial plexus nerve blocks. Despite the widespread use of this platform as a medical information source, there is no regulation for the quality or content of the videos. The goals of this study are to evaluate the content of material on YouTube relevant to performance of brachial plexus nerve blocks and its quality as a visual digital information source. Methods: The YouTube search was performed using keywords associated with brachial plexus nerve blocks and the final 86 videos out of 374 were included in the watch list. The assessors scored the videos separately according to the Questionnaires. Questionnaire-1 (Q1) was prepared according to the ASRA guidelines/Miller's Anesthesia as a reference text book, and Questionnaire-2 (Q2) was formulated using a modification of the criteria in Evaluation of Video Media Guidelines. Results: 72 ultrasound-guided and 14 nerve-stimulator guided block videos were evaluated. In Q1, for ultrasound-guided videos, the least scores were for Q1-5 (1.38) regarding the complications, and the greatest scores were for Q1-13 (3.30) regarding the sono-anatomic image. In videos with nerve stimulator, the lowest and the highest scores were given for Q1-7 (1.64) regarding the equipment and Q1-12 (3.60) regarding the explanation of muscle twitches respectively. In Q2, 65.3% of ultrasound-guided and 42.8% of blocks with nerve-stimulator had worse than satisfactory scores. Conclusion: The majority of the videos examined for this study lack the comprehensive approach necessary to safely guide someone seeking information about brachial plexus nerve blocks.
Resumo Justificativa e objetivos: O YouTube, site de compartilhamento de vídeos mais popular, contém um número significativo de vídeos médicos, incluindo bloqueios do plexo braquial. Apesar do uso generalizado dessa plataforma como fonte de informação médica, não há regulamentação para a qualidade ou o conteúdo dos vídeos. O objetivo deste estudo é avaliar o conteúdo do material no YouTube relevante para o desempenho do bloqueio do plexo braquial e sua qualidade como fonte de informação visual digital. Métodos: A pesquisa no YouTube foi realizada usando palavras-chave associadas ao bloqueio do plexo braquial e, de 374 vídeos, 86 foram incluídos na lista de observação. Os avaliadores classificaram os vídeos separadamente, de acordo com os questionários. O questionário-1 (Q1) foi preparado de acordo com as diretrizes da ASRA/Miller's Anesthesia como livro de referência e o Questionário-2 (Q2) foi formulado usando uma modificação dos critérios em Avaliação de Diretrizes para Mídia de Vídeo. Resultados: No total, 72 vídeos sobre bloqueios guiados por ultrassom e 14 vídeos sobre bloqueios com estimulador de nervos foram avaliados. No Q1, para os vídeos apresentando bloqueios guiados por ultrassom, os menores escores foram para Q1-5 (1,38) em relação às complicações e os maiores escores foram para Q1-13 (3,30) em relação à imagem sonoanatômica. Nos vídeos que apresentaram bloqueios com estimulador de nervos, os menores e os maiores escores foram dados para Q1-7 (1,64) em relação ao equipamento e Q1-12 (3,60) em relação à explicação das contrações musculares, respectivamente. No Q2, 65,3% dos bloqueios guiados por ultrassom e 42,8% dos bloqueios com estimulador de nervos apresentaram escores abaixo de satisfatórios. Conclusões: A maioria dos vídeos examinados para este estudo carece da abordagem abrangente necessária para orientar com segurança as pessoas que buscam informações sobre o bloqueio do plexo braquial.
Subject(s)
Humans , Consumer Health Information/methods , Social Media/standards , Brachial Plexus Block , Video Recording , Patient Education as Topic/methods , Patient Education as Topic/standards , Surveys and Questionnaires , Consumer Health Information/standardsABSTRACT
Brachial plexus block (BPB) under ultrasound guidance has come to be widely used. However, nerve injury has been reported following ultrasound-guided BPB. We hypothesized that BPB under ultrasound guidance in conjunction with real-time electrical nerve stimulation would help us prevent nerve injury and do more successful procedure. Here, we report the successful induction and maintenance of ultrasound-guided BPB and the achievement of good peri- and postoperative pain control using a conductive catheter, the EpiStim(R).
Subject(s)
Brachial Plexus , Catheters , Pain Management , Pain, Postoperative , Peripheral Nerves , Radial Nerve , UltrasonographyABSTRACT
BACKGROUND: The purpose of this study was to evaluate the effect of the addition of 5 mg dexamethasone to 10 ml of 0.5% levobupivacaine on postoperative analgesic effects of ultrasound guided-interscalene brachial plexus block (ISBPB) in arthroscopic shoulder surgery under general anesthesia. METHODS: In 60 patients scheduled for arthroscopic shoulder surgery that underwent general anesthesia, ISBPB was preoperatively performed with 10 ml of 0.5% levobupivacaine under the guidance of ultrasound and a nerve stimulator. Patients were randomly allocated to receive the same volume of normal saline (Group I), 5 mg of dexamethasone (Group II), or 1 : 400,000 epinephrine (Group III) as an adjuvant to the mixture. A blind observer recorded total analgesic consumption, sleep quality, complication, and patient satisfaction using a verbal numerical rating scale (VNRS) at 0, 1, 6, 12, 24, 48 h after the operation. RESULTS: All patients had successful ISBPB and excellent analgesic effects less than VNRS 4 up to discharge time. VNRS in Group II at 12 h and 48 h was statistically much lower than in Group I and III. There were no differences in total analgesic consumption, sleep quality, complications, and patient satisfaction. CONCLUSIONS: We conclude that the addition of 5 mg of dexamethasone to 10 ml of 0.5% levobupivacaine in ISBPB showed improvement of postoperative analgesia for arthroscopic shoulder operation without any specific complications.