Suprascapular block associated with supraclavicular block: An alternative to isolated interscalene block for analgesia in shoulder instability surgery?

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.

Effect of warming bupivacaine 0.5% on ultrasound-guided axillary plexus block. Randomized prospective double-blind study.

OBJECTIVE: To evaluate the effect of warming bupivacaine 0.5% on ultrasound-guided axillary brachial plexus block. STUDY DESIGN: Prospective, randomized, double-blind. PATIENTS AND METHODS: Eighty patients undergoing elective or emergency surgery beyond the distal third of the upper limb were divided into two groups of 40 patients: the warm group received 15mL bupivacaine 0.5% heated to 37°C; the cold group received 15mL 0.5% bupivacaine stored for at least 24hours in the lower compartment of a refrigerator at 13-15°C. Onset and duration of sensory and motor blocks were evaluated every 5minutes for 40minutes. Postoperative pain was evaluated at 1, 3, 6, 12 and 24hours. Effective analgesia time was recorded as the interval between anesthetic injection and the first analgesia requirement (VAS>30mm). RESULTS: Time to onset of sensory and motor block was significantly shorter in the warm group, and mean duration of sensory and motor block and of postoperative analgesia significantly longer. CONCLUSION: Warming bupivacaine 0.5% to 37°C accelerated onset of sensory and motor block and extended action duration.

Multiple scattering by infinitely long cylindrical glass inclusions in a saturated Biot porous medium of glass beads.

The resonance spectrum of sets of two to five infinitely long parallel cylindrical glass inclusions in a fluid saturated porous matrix of unconsolidated glass beads is investigated. The ratio of bead diameters to inclusion diameters is 1/5. The far field form functions and the related phase derivatives are calculated by using an exact multiple scattering formalism and by assuming that the porous medium obeys Biot's model. In order to validate this hypothesis, comparisons between theory and experiments are done in the special case of a fast incident wave on a set of two and three inclusions.

Band gap structures in underwater screens of periodically spaced porous plates.

Acoustic properties of different periodic structures composed of alternating fluid and fluid-saturated porous layers obeying Biot's theory are investigated. At first, the network of modes and the transmission coefficients of finite structures of six plates are studied in the frequency-angle of incidence plane. It is shown that the network of modes concentrates in localized domains of the plane where the transmission coefficients will take the greatest values. With this minimum of six plates, the structures exhibit the main features as for structures containing more plates, especially those with an infinite number of plates. Then, considering infinite structures the band gap calculations are led using the Bloch-Floquet theorem. The evanescent and propagative zones in the frequency-angle of incidence plane are determined. What is proposed here is a class of underwater porous screens that exhibits band gaps extending over great angular domains and enlarging in the frequency domain when the pores at the interfaces of the porous plates are sealed. The effect of porosity on the band gaps is also investigated.