Browsing by Subject "Nerve block"

Now showing 1 - 3 of 3
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    Comparison of lidocaine-dexmedetomidine and lidocaine-saline on the characteristics of the modified forearm bier block: A clinical trial
    (Wolters Kluwer, 2021) Ghaderi, Kamal; Rahmani, Khaled; Rahmanpanah, Nasser; Shami, Shoaleh; Zahedi, Farhad; Nasseri, Karim; Medicine, School of Medicine
    Background and aims: Forearm Modified Bier Block (FMBB) reduces local anesthetic systemic toxicity risks compared to the traditional method. This study was designed and implemented to compare the effects of lidocaine-dexmedetomidine (LD) and lidocaine-saline (LS) on the characteristics of the MFBB in distal forearm and hand surgery. Material and methods: In this randomized double-blind trial, which was conducted after obtaining institutional ethical committee approval, 60 patients were enrolled and randomly divided into two groups. In both groups, the analgesic base of the block was 20 mL lidocaine 0.5% that was supplemented by 1 μg/kg dexmedetomidine in the LD group or 1 mL of 0.9% saline in the LS group. Patients were evaluated for the onset and duration of sensory block, time of the first request for postoperative analgesic, and analgesic request frequency during the first 24 h after surgery. Results: Sensory block onset in the LD group (7.1 ± 1.4 min) compared to the LS group (8.4 ± 1.4) was faster (P = 0.008). Duration of the sensory block in LD group (49.7 ± 7.2 min) was longer than LS group (33.3 ± 2.6) (P < 0.001). Compared to LS group, time of the first request for postoperative analgesic in LD group was later (P = 0.6), and had lesser analgesic requests during the first 24 h after surgery (P < 0.001). Conclusion: Based on our study's finding, adding dexmedetomidine to lidocaine in the MFBB increases the duration of sensory block.
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    In-vivo application of low frequency alternating currents on porcine cervical vagus nerve evokes reversible nerve conduction block
    (BMC, 2021-06-30) Muzquiz, Maria Ivette; Richardson, Lindsay; Vetter, Christian; Smolik, Macallister; Alhawwash, Awadh; Goodwill, Adam; Bashirullah, Rizwan; Carr, Michael; Yoshida, Ken; Biomedical Engineering, School of Engineering and Technology
    Background: This paper describes a method to reversibly block nerve conduction through direct application of a 1 Hz sinusoidal current waveform delivered through a bipolar nerve cuff electrode. This low frequency alternating current (LFAC) waveform was previously shown to reversibly block the effects of vagal pulse stimulation evoked bradycardia in-vivo in the anaesthetised rat model (Mintch et al. 2019). The present work measured the effectiveness of LFAC block on larger caliber myelinated vagal afferent fibers in human sized nerve bundles projecting to changes in breathing rate mediated by the Hering-Breuer (HB) reflex in anaesthetized domestic swine (n=5). Methods: Two bipolar cuff electrodes were implanted unilaterally to the left cervical vagus nerve, which was crushed caudal to the electrodes to eliminate cardiac effects. A tripolar recording cuff electrode was placed rostral to the bipolar stimulating electrodes on the same nerve to measure changes in the compound nerve action potentials (CNAP) elicited by the vagal pulse stimulation and conditioned by the LFAC waveform. Standard pulse stimulation was applied at a sufficient level to induce a reduction in breathing rate through the HB reflex. If unblocked, the HB reflex would cause breathing to slow down and potentially halt completely. Block was quantified by the ability of LFAC to reduce the effect of the HB reflex by monitoring the respiration rate during LFAC alone, LFAC and vagal stimulation, and vagal stimulation alone. Results: LFAC achieved 87.2 ±8.8% block (n=5) at current levels of 1.1 ±0.3 mAp (current to peak), which was well within the water window of the working electrode. CNAP showed changes that directly correlated to the effectiveness of LFAC block, which manifested itself as the slowing and amplitude reduction of components of the CNAP. Conclusion: These novel findings suggest that LFAC is a potential alternative or complementary method to other electrical blocking techniques in clinical applications.
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    Pain Control in Breast Surgery: Survey of Current Practice and Recommendations for Optimizing Management—American Society of Breast Surgeons Opioid/Pain Control Workgroup
    (Springer, 2020-04) Rao, Roshni; Jackson, Rubie Sue; Rosen, Barry; Brenin, David; Cornett, Wendy; Fayanju, Oluwadamilola M.; Chen, Steven L.; Golesorkhi, Negar; Ludwig, Kandice; Ma, Ayemoethu; Koslow Mautner, Starr; Sowden, Michelle; Wilke, Lee; Wexelman, Barbara; Blair, Sarah; Gary, Monique; Grobmyer, Stephen; Hwang, E. Shelley; James, Ted; Kapoor, Nimmi S.; Lewis, Jaime; Lizarraga, Ingrid; Miller, Megan; Neuman, Heather; Showalter, Shayna; Smith, Linda; Froman, Joshua; Medicine, School of Medicine
    Introduction: The opioid epidemic in the United States is a public health crisis. Breast surgeons are obligated to provide good pain control for their patients after surgery but also must minimize administration of narcotics to prevent a surgical episode of care from becoming a patient's gateway into opioid dependence. Methods: A survey to ascertain pain management practice patterns after breast surgery was performed. A review of currently available literature that was specific to breast surgery was performed to create recommendations regarding pain management strategies. Results: A total of 609 surgeons completed the survey and demonstrated significant variations in pain management practices, specifically within regards to utilization of regional anesthesia (e.g., nerve blocks), and quantity of prescribed narcotics. There is excellent data to guide the use of local and regional anesthesia. There are, however, fewer studies to guide narcotic recommendations; thus, these recommendations were guided by prevailing practice patterns. Conclusions: Pain management practices after breast surgery have significant variation and represent an opportunity to improve patient safety and quality of care. Multimodality approaches in conjunction with standardized quantities of narcotics are recommended.