Evaluation of Monitored Anesthesia Care Involving Sedation and Axillary Nerve Block for Day-Case Hand Surgery.

BACKGROUND: Ultrasound-guided axillary brachial plexus block (ABPB) is a technique of choice for regional anesthesia during hand and forearm surgery. Intravenous sedation may facilitate this procedure, particularly for those suffering from anxiety; however, it can also be associated with respiratory, cardiovascular, and neurological side effects. The objective of this study was to evaluate the effect of intravenous sedation on perioperative respiratory depression for patients undergoing day-case hand surgery under ABPB. METHODS: A prospective, observational, single-center study was conducted between 1 May and 1 November 2016. RESULTS: A total of 2318 patients were included, with 501 patients in the group with IV sedation and 1817 in the group without. A multivariable propensity-score matched analysis showed that the variables associated with the number of desaturation were: (i) sedation (aRR 1.534 [95% CI: 1.283 to 1.836]), (ii) age and sex, (iii) type of surgery, and iv) Body Mass Index (BMI). CONCLUSIONS: Supplementing ABPB with IV sedation was associated with an increased rate of respiratory depression (episodes of desaturation) compared to fully awakened patients. The rate of oxygen administration was also higher in sedated patients even though they had fewer cases of chronic respiratory diseases and fewer were active smokers than non-sedated patients. Future research should consider precisely evaluating patient satisfaction, as well as the differences between sedation and drug-free approaches.

Complications associated with 27 031 ultrasound-guided axillary brachial plexus blocks: a web-based survey of 36 French centres.

BACKGROUND: Ultrasound guidance improves the efficacy of peripheral nerve blocks, reducing performance time and local anaesthetic doses. It should also reduce the risk of systemic toxicity of local anaesthetic and nerve injuries. OBJECTIVE: The primary objective of this prospective study was to estimate the incidence of immediate complications related to ultrasound-guided axillary brachial plexus blocks in a multicentre observational cohort. DESIGN: Prospective multicentre observational study. SETTING: Thirty-six French centres participated in the study between 2009 and 2012. PATIENTS: A total of 27 031 axillary brachial plexus blocks were recorded. INTERVENTIONS: The study objective, the incidence of immediate complications related to ultrasound-guided axillary brachial plexus blocks (intravascular injection of local anaesthetic and neurological deficit at hospital discharge), was based on data collected by anaesthesiologists through a web-based case report form. MAIN OUTCOME MEASURE: Incidence of immediate complications related to ultrasound-guided axillary brachial plexus blocks. RESULTS: Of 27 031 blocks performed, the incidence of systemic toxicity of local anaesthetic was very low at 1.5 per 10 000, and the overall incidence of postoperative neurological symptoms was 0.37 per 10 000. CONCLUSION: We have reported a large series of ultrasound-guided axillary brachial plexus blocks in a multicentre study. Our results confirm the low incidence of local anaesthetic systemic toxicity and postoperative neurological complications as previously described.

Background infusion is not beneficial during labor patient-controlled analgesia with 0.1% ropivacaine plus 0.5 microg/ml sufentanil.

BACKGROUND: Although patient-controlled epidural analgesia (PCEA) during labor has been extensively studied in recent clinical trials, the role of a background infusion associated with self-administered boluses is still debated. The authors designed a study to assess whether the use of PCEA with or without background infusion could improve the comfort of parturients and their satisfaction during labor and delivery without affecting the total consumption of local anesthetics. METHODS: One hundred thirty-three laboring parturients requesting epidural analgesia administered via PCEA with a solution of 0.1% ropivacaine plus 0.5 microg/ml sufentanil were randomly assigned to four groups, according to the rate of background infusion used (0, 3, 6, and 9 ml/h). Local anesthetic requirements, maternal satisfaction, verbal pain scores, incidence of side effects, and outcome of labor were compared among groups. RESULTS: Patient demographics, labor characteristics, side effects, and Apgar scores were similar in each group. No significant differences were observed between groups in verbal pain scores during labor, number of supplemental boluses, or maternal satisfaction. A significantly greater overall total drug consumption with a 6-ml/h or a 9-ml/h background infusion (74 and 78 ml, respectively) was observed in comparison with PCEA without a background infusion (55 ml). A similar relation was observed for hourly use during both the first and the second stage of labor. CONCLUSION: The results of this study suggest that the use of a background infusion with PCEA during labor leads to a greater consumption of anesthetic solution without improving comfort and satisfaction of parturients. Moreover, not using a background infusion does not provide an increased incidence of supplemental boluses (which might cause problems in a busy unit) and allows for a substantial reduction in the cost of analgesia.