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Peripheral nerve blocks involve injecting local anesthesia near or around a nerve or nerve plexus. This form of anesthesia allows surgeons to perform more complex surgeries and provides extended postoperative analgesia for patients. Patients experience reduced postoperative pain and length of hospital stay and increased satisfaction with the outcom...
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Context 1
... there, it divides into the tibial and common peroneal nerves. The sciatic nerve provides sensory innervation to the posterior thigh, the whole leg below the knee, and the foot (Figure 7). Access to the nerve can be obtained with the patient in the supine, side lying, prone, or lithotomy position. ...
Context 2
... femoral nerve has its origins in the second, third, and fourth lumbar nerves and is the largest branch of the lumbar plexus. 6 The femoral nerve provides motor and sensory innervations of most of the anterior thigh and knee 10 ( Figure 6), which makes this block an excellent choice for patients undergoing anterior thigh or knee surgery (eg, patella surgery). Access to the femoral nerve can be achieved with the patient in the supine position. Anatomic landmarks for femoral block administration include the femoral crease and the femoral artery pulse. The femoral nerve innervates several muscle groups. Needle insertion for a femoral block is immediately lateral to the patient’s femoral artery pulse. After location of the pulse, the anesthesia professional attaches the needle to a nerve stimulator and observes for visible twitching of the quadriceps muscle when stimulated. This is the most reliable indication that the needle is cor- rectly placed. 6 The sciatic nerve originates from L 4 , L 5 , S 1 , S 2 , and S 3 and runs down the posterior aspect of the thigh to the popliteal fossa. From there, it divides into the tibial and common peroneal nerves. The sciatic nerve provides sensory innervation to the posterior thigh, the whole leg below the knee, and the foot (Figure 7). Access to the nerve can be obtained with the patient in the supine, side lying, prone, or lithotomy position. The sciatic nerve is the longest nerve in the body, and a successful block of this nerve may take as long as 30 minutes to take effect. A successful sciatic block manifests itself by the patient exhibiting footdrop, which is a characteristic of motor paresis. A sciatic block may be used alone or in conjunction with a femoral block to provide analgesia to the knee, lower leg, and foot. Although complications of nerve blocks are infrequent, it is important for all staff members to observe the patient for early signs of complications (Table 1). The following complications can be seen in patients undergoing nerve ...
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Citations
... Complications associated with PNBs include hematoma from injury to adjacent blood vessels, nerve damage from inadvertent injection directly into the nerve, toxicity from intravascular injection of local anesthetic, and injury of adjacent structures. 28 Although, these complications are extremely rare they can potentially be very serious. Relatively large amounts of local anesthetic are used for PNB which can contribute to local anesthetic systemic toxicity. ...
Purpose: Femoral nerve blocks (FNB) for anterior cruciate ligament reconstruction (ACLR) can effectively reduce post-operative pain, though this is tempered with the potential for quadriceps weakness, and subsequent concerns regarding impeded rehabilitation. The purpose of this retrospective study was to assess post-ACLR differences in International Knee Documentation Committee Subjective Knee Form (IKDC) scores in patients who did not (NB) and did (FB) receive perioperative FNB. Methods: A retrospective review was performed to identify all adults undergoing ACLR at Tripler Army Medical Center between January 2013 and August 2016, with International Knee Documentation Committee (IKDC) outcome scores from pre-surgery to 6-12 months post-surgery. Patients were then divided into two groups, with the FB group being patients who received femoral nerve blocks (FNBs), and NB group patients not receiving a block. Demographics included age, sex, BMI, and ASA category. IKDC scores were converted to normative values. Variables were analyzed using Mann-Whitney-U, ANCOVA, and Chi-square tests. Results: A total of 123 ACLR patients were identified with complete IKDC scores, of which 41 did not receive a femoral nerve block. Preoperatively, IKDC scores were statistically similar between NB (Mean=40.82,SD=15.82) and FB groups (Mean=40.03,SD=15.36), (p=.79). There were no significant group differences in time-to-follow-up (p=.30), age (p=.74), or BMI (p=.11), gender (p=.27) or ASA category (p=.26). A repeated measures ANCOVA examined whether the treatment groups differed in IKDC score changes from pre-surgery to follow-up. Both groups had a significant increase in IKDC score from pre-surgery to follow-up (p<0.008). However, there was no significant difference between groups (p<0.8) (Figure 2). Conclusion: This retrospective review of outcomes after ACLR surgery indicate knee functioning improvements after ACLR did not differ between patients who did and did not receive FNB. Future rigorous studies are needed to fully examine FNB effects on other patient-reported and clinical outcomes after ACLR. Data Sources: PubMED, Cochrane Library, CINAHL, and Google Search. Keywords: International Knee Documentation Committee, IKDC, anterior cruciate ligament, ACL, reconstruction, repair, surgery, femoral nerve block, nerve block, quadriceps
Introduction
Multimodal analgesia has been associated with reduced opioid utilization, opioid-related complications, and improved recovery in various orthopedic surgeries; however, large sample size data is lacking for shoulder surgery.
Methods
A retrospective review using the Premier Healthcare Database of patients who underwent inpatient or outpatient (reverse, total, partial) shoulder arthroplasty from 2010 to 2019. Opioid-only analgesia was compared with multimodal analgesia, categorized into 1, 2, or >2 additional analgesic modes, with/without a nerve block. Multivariable regression models measured associations between multimodal analgesia and opioid charges (in oral morphine equivalents (OME)), cost and length of stay, and opioid-related adverse effects (approximated by naloxone use). We report % change and 95% CIs.
Results
Among 176 225 procedures, 169 679 (75.7% multimodal analgesia use) and 6546 (37.8% multimodal analgesia use) were inpatient and outpatient shoulder arthroplasties, respectively. Among inpatients, multimodal analgesia (>2 modes) without a nerve block (vs opioid-only analgesia) was associated with adjusted reductions in OMEs on postoperative day 1: −19.4% (95% CI −21.2% to −17.6%/representing unadjusted median OME reductions from 45 to 30 mg). For total hospitalization, this was −6.0% (95% CI −7.2% to −4.9%/representing unadjusted median OME reductions from 173 to 135 mg). Conversely, for outpatients, this was +13.7% change in OMEs (95% CI +4.4% to +23.0%/representing unadjusted median OME increases from 110 to 131 mg). In both settings, addition of a nerve block to multimodal analgesia attenuated effects in terms of opioid charges.
Conclusions
Multimodal analgesia is associated with reductions in opioid charges—specifically inpatient setting—but not various other outcomes.
Medical simulation training is widely used to effectively train for invasive medical procedures such peripheral nerve blocks. Traditionally, accurate haptic training relies on expensive cadavers, mannequins, or advanced haptic robots. Proposed herein is a novel concept for haptic training called the Low Cost Haptic Force Needle Insertion Simulator (LCNIS), which uses material fracture inside disposable cartridges to accurately replicate the force of inserting a needle into tissue. Cadaver and material fracture experiments are performed to develop and determine the accuracy of the LCNIS. The material testing showed that polycarbonate had the highest maximum needle puncture force of the materials tested, 9.85 N, and that fluorinated ethylene propylene had the lowest maximum puncture force, 0.84 N. The cadaver results showed that the error between the three peak forces in a cadaver and a cadaver mimicking cartridge was 1.00 N, 0.01 N, and 1.54 N. The standard deviation of these peaks was 0.60 N, 0.55 N, and 0.41 N. This novel method of haptic simulation can easily be adapted to recreate any type of force and therefore could be utilized to train for a wide variety of medical procedures.
Blockade of the brachial plexus is an effective method for providing anesthesia to the upper limb from the shoulder to the fingertips. There are multiple approaches to blocking the brachial plexus which are dependent on the block indication, surgery or procedure being performed, patientspecific body habitus, medical comorbidities, and individual anatomy variations. This review will address the indications, probe placement, and sonoanatomy for ultrasoundguided interscalene block, superior trunk block, supraclavicular brachial plexus block, infraclavicular brachial plexus block, and axillary brachial plexus block.
