Kai Henrik Wiborg Lange

Nordsjællands Hospital, Hillerød, Denmark · Anaesthesia

The transversus abdominis plane (TAP) block is a widely used nerve block. However, basic block characteristics are poorly described. The purpose of this study was to assess the cutaneous sensory block area, muscle-relaxing effect, and block duration. Sixteen healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block wit...

We have developed a peripheral nerve catheter, attached to a needle, which works like an adjustable suture. We used in-plane ultrasound guidance to place 45 catheters close to the femoral, saphenous, sciatic and distal tibial nerves in cadaver legs. We displaced catheters after their initial placement and then attempted to return them to their orig...

Background: Changes in digit skin temperature may be used to predict and determine upper limb nerve block success. We investigated whether a temperature difference between the blocked and the nonblocked hands, simply registered by touching the skin of the 5th and 2nd digit was valid and reliable as a diagnostic test for predicting a successful lat...

Key points We tested the recovery of motor axon conduction and multiple measures of excitability by ‘threshold‐tracking’ after ultrasound‐guided distal median nerve regional anaesthesia by lidocaine. Lidocaine caused a transient conduction failure that recovered completely by 3 h, whereas excitability recovered only partially by 6 h and fully by 24...

Interscalene brachial plexus block (IBPB) is the gold standard for perioperative pain management in shoulder surgery. However, a more distal technique would be desirable to avoid the side effects and potential serious complications of IBPB. Therefore, the aim of the present study was to develop and describe a new method to perform an ultrasound-gui...

Background and objectives The transversus abdominis plane (TAP) block is the most widely used abdominal field block in colorectal surgery with a postoperative enhanced recovery pathway. We aimed to determine whether the laparoscopic-assisted and ultrasound-guided TAP (US-TAP) blocks provide superior pain relief compared with placebo. We separately...

Introduction: Different approaches and techniques are used to apply a transversus abdominis plane block (TAP), but their characteristics are poorly described. Precise injection of local anaesthetic is considered crucial to achieving the desired block effect. Laparoscopic-assisted TAP (L-TAP) is a blind technique and potentially less reliable than...

Background: Peripheral nerve blocks may provide better conditions for closed reduction of distal radius fractures as compared to other more frequently used modalities. In this systematic review, we evaluate existing evidence on the effect and harm of peripheral nerve blocks for closed reduction of distal radius fractures in adults. Methods: We p...

Introduction This protocol describes a systematic review and meta‐analysis to evaluate the clinical effects of mixing short‐ and long‐acting local anaesthetics in peripheral nerve blocks. Clinicians often combine short‐ and long‐acting local anaesthetics to achieve a briefer onset time. However, this may come with a prize, namely a shorter total du...

Background Current methods of anaesthesia used for closed reduction of distal radial fractures may be insufficient for pain relief and muscle relaxation, potentially compromising reduction quality and patient satisfaction. Peripheral nerve blocks have already been implemented for surgery of wrist fractures and may provide optimal conditions for clo...

Background and objectives The transversus abdominis plane block (TAP) can be applied using different approaches, resulting in varying cutaneous analgesic distributions. This study aimed to assess the cutaneous sensory block area (CSBA) after ultrasound-guided TAP (US-TAP) using the subcostal approach. Methods Thirty patients undergoing elective la...

Evidence in perioperative care is insufficient. There is an urgent need for large perioperative research programmes, including pragmatic randomised trials, testing daily clinical treatments and unanswered question, thereby providing solid evidence for effects of interventions given to a large and growing number of patients undergoing surgery and an...

Introduction: This study aimed to assess risk factors for difficult fetal extraction in emergency caesarean sections, focusing on top-up epidural anesthesia compared to spinal anesthesia. Additionally, this study addressed consequences of difficult fetal extraction on neonatal and maternal morbidity. Material and methods: This retrospective regi...

Background: A shoulder block without lung affection is desirable. In this study we compared a low vs a high volume of a modified supraclavicular brachial plexus block. We hypothesized that a low volume of local anaesthetic would provide non-inferior block success rate with better preserved lung function. Methods: Healthy volunteers were randomis...

Systematic reviews associate peripheral nerve blocks based on anatomic landmarks or nerve stimulation with reduced pain and need for systemic analgesia in hip fracture patients. We aimed to investigate the effect of ultrasound-guided nerve blocks compared to conventional analgesia for preoperative pain management in hip fractures. Five databases we...

Systematic reviews associate peripheral nerve blocks based on anatomic landmarks or nerve stimulation with reduced pain and need for systemic analgesia in hip fracture patients. We aimed to investigate the effect of ultrasound-guided nerve blocks compared to nerve blocks without the use of ultrasound and to conventional analgesia for preoperative p...

Background: A proximal suprascapular nerve block has been suggested as an alternative to an interscalene brachial plexus block after arthroscopic shoulder surgery. The aim of this randomized controlled trial was to compare the analgesic and opioid sparing effect of a low volume proximal suprascapular nerve block with placebo in patients with moder...

Introduction: After failed mask ventilation and tracheal intubation, guidelines issued by the Difficult Airway Society recommend placing a 2nd generation supraglottic airway device to secure oxygenation. Ultimately, a secure airway can be obtained by tracheal intubation through the supraglottic airway device using a bronchoscope. In this randomise...

Introduction Transversus abdominis plane (TAP) blocks are used for post-operative pain management, but their efficacy remains unclear. We aim to investigate the effect of two TAP block methods in minimally invasive colon surgery. Methods This will be a double-blind, randomised and controlled multicentre trial including 360 adults who are planned fo...

Background Trials comparing programmed, intermittent boluses (PIB) and continuous infusion in catheter-based nerve blocks found no analgesic differences. However, as these trials used equal doses of local anesthetic (LA), the time of action of each bolus was not accounted for. Therefore, the dose-sparing benefits of PIB may have been overlooked. We...

Introduction The transversus abdominis plane block is widely used in postoperative pain management after abdominal surgery. However, large interindividual variation in the cutaneous distribution area of the block has been demonstrated. The purpose of the present study was to explore the reproducibility of the block by determining the intraindividua...

During exercise, energy turnover increases and adrenergic mechanisms play an important role in this regulation. In addition, increased adrenergic activity during exercise also results in an increased heart rate and in an enhanced force of myocardial contraction as well as in vasoconstriction in the splanchnic circulation, in the kidneys, and in non...

Background: The sensory innervation of the shoulder is complex and there are variations in the branching patterns of the sensory fibres. Articular branches from the axillary nerve to the subacromial bursa are described in more than 50% of investigated shoulders but the isolated contribution of sensory input from the axillary nerve has never been i...

Introduction. Cefuroxime is an important antibiotic to treat several serious infections. Rapid elimination through the kidneys and the variation in MICs of various susceptible pathogens such as Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Streptococcus pneumoniae give rise to dosing issues, especially in otherwise healthy pati...

Background and objectives Characteristics of a nerve block depend on the distribution of local anesthetic (LA) close to the nerve. The relationship between longitudinal distribution of LA and nerve block characteristics has not been investigated in vivo , but one in vitro study showed decrements in action potential amplitudes with increasing exposu...

Aims The aim of this study was to investigate the difference in functional outcome after repair and non-repair of the pronator quadratus muscle in patients undergoing surgical treatment for a distal radial fracture with volar plating. Patients and Methods A total of 72 patients with a distal radial fracture were included in this randomized clinica...

Background: The effect of local anaesthetic concentration on peripheral nerve block duration is unclear. Recent clinical trials found nerve blocks of equivalent duration despite changing local anaesthetic concentration but with a fixed local anaesthetic dose. A criticism of these studies is that the local anaesthetic doses used were above the prop...

Background: The reported variation in nerve block duration is considerable. To individualise nerve block therapy, knowledge of the intra- versus inter-individual variability is essential. We investigated the relative contribution of these two parameters to the overall nerve block duration variability. Methods: With ethics committee approval, we...

Background: Sciatic nerve blocks are used for many orthopaedic procedures on the knee, lower leg, foot and ankle.However, as nerve block durations vary considerably, timing of supplemental analgesia is challenging. Therefore, knowledge on the effect of local anaesthetic (LA) dose on block duration is important to outweigh the benefits of increasin...

Background: Repair of the pronator quadratus (PQ) muscle with sutures has been reported durable after volar plating of distal radius fractures (DRF). It is unclear how the muscle reacts if not repaired and if a retracted muscle correlates to worse functional outcome or complications. In this study, we use ultrasound to investigate the anatomy of th...

Background We performed a randomised blinded pilot study in 16 healthy volunteers to assess whether placing a suture‐method catheter in the adductor canal is feasible with two different insertion techniques. Methods Each volunteer had a suture‐method catheter placed approximately halfway between the superior anterior iliac spine and base of the pa...

Background: We performed a randomized, blinded pilot study in 12 volunteers to assess the feasibility to reposition an intentionally displaced suture-method catheter for two different insertion techniques for adductor canal block. Methods: Each volunteer had an ultrasound-guided suture-method catheter placed in the adductor canal (AC) in both le...

The volume‐duration relationship using low concentrations of ropivacaine for peripheral nerve blocks is unknown, even though low concentrations of ropivacaine are increasingly used clinically. We investigated the effect of ropivacaine 0.2% on common peroneal nerve block duration. With ethical committee approval, 60 consenting, healthy volunteers we...

Peripheral nerve blocks (PNBs) using local anesthetic (LA) are superior to systemic analgesia for management of post-operative pain. An insufficiently short PNB duration following single-shot LA can be optimized by development of extended release formulations among which liposomes have been shown to be the least toxic. In vivo rodent models for PNB...

We aimed to examine to what extent a lateral infraclavicular brachial plexus block affected the axillary and the suprascapular nerve. We included patients undergoing hand surgery anaesthetised with a lateral infraclavicular brachial plexus block. Our primary outcome was the relative change in surface electromyography during maximum voluntary isomet...

Background and objectives: The speed of local anesthetic (LA) injections in peripheral regional anesthesia ranges from slow continuous infusions (3-12 mL/h) to rapid manual injections (>7500 mL/h). Optimizing injection speed could augment the spread of LA toward the targeted nerves and influence nerve block characteristics. The objective of this s...

Abstract Background The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surger...

Background As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. Methods We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary...

Background Prioritization of acutely ill patients in the Emergency Department remains a challenge. We aimed to evaluate whether routine blood tests can predict mortality in unselected patients in an emergency department and to compare risk prediction with a formalized triage algorithm. MethodsA prospective observational cohort study of 12,661 conse...

Purpose: Increased distal skin temperature can be used to predict the success of lateral infraclavicular (LIC) block. We hypothesized that an "eyeball test" of specific infrared thermographic patterns after LIC block could be used to determine block success. Methods: In this observational study, five observers trained in four distinct thermograp...

We performed a randomised double-blind pilot study in 16 healthy volunteers to investigate the success rate for placing a new suture-method catheter for sciatic nerve block. A catheter was inserted into both legs of volunteers and each was randomly allocated to receive 15 ml lidocaine 2% through the catheter in one leg and 15 ml saline in the other...

Hypoglycaemia is associated with reduced skin temperature (Ts). We studied whether infrared thermography can detect Ts changes during hypoglycaemia in patients with type 1 diabetes and how the Ts response differs between patients with normal hypoglycaemia awareness and hypoglycaemia unawareness. Twenty-four patients with type 1 diabetes (ten aware,...

The prognostic value of blood lactate as a predictor of adverse outcome in the acutely ill patient is unclear. The aim of this study was to investigate if a peripheral venous lactate measurement, taken at admission, is associated with in-hospital mortality in acutely ill patients with all diagnosis. Furthermore, we wanted to investigate if the test...

Background: Existing techniques for placing and maintaining the position of peripheral nerve catheters are associated with variable success rates and frequent secondary failures. These factors may affect the clinical efficacy and usefulness of peripheral nerve catheters. Methods: We developed a new concept and prototype for ultrasound-guided in-...

Background: Increases in skin temperature may be used as an early predictor of the success of interscalene brachial plexus block (IBPB), but we lack detailed information on the thermographic response. Objective: To investigate and characterise the thermographic response after IBPBs. Design: Prospective observational study. Setting: Universit...

Background The standard approach for the suprascapular nerve block is deep in the supraspinous fossa. However, with this approach, the suprascapular nerve is difficult to visualize by ultrasound. The aim of this study was to describe a new method to visualize and selectively block the suprascapular nerve in a more superficial and proximal location....

Background: Brachial plexus blocks cause changes in hand and digit skin temperature. We investigated thermographic patterns after the lateral infraclavicular brachial plexus block. We hypothesised that a successful lateral infraclavicular block could be predicted by increased skin temperature of the 2nd and 5th digits. Methods: We performed an u...

(EN)The present application relates to an echogenic indwelling catheter, an assembly and a method for medicating a patient with medication such as anaesthetics or other suitable drugs. In one embodiment, the echogenic indwelling catheter comprises a catheter shaft (1) comprising a bore (2), a plurality of radial holes (3) distributed along at least...

Background We know from previous studies that increasing age, abnormal vital signs and abnormal acid-base status are strongly associated with in-hospital mortality in unselected patients admitted acutely to hospital. A model including this information will make us able to explore associations and predict the risk for future patients. Our aim was to...

During exercise, energy turnover increases and adrenergic mechanisms play an important role in this regulation. In addition, increased adrenergic activity during exercise also results in an increased heart rate and in an enhanced force of myocardial contraction as well as in vasoconstriction in the splanchnic circulation, in the kidneys, and in non...

Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quant...

Management and care of the acutely ill patient has improved over the last years due to introduction of systematic assessment and accelerated treatment protocols. We have, however, sparse knowledge of the association between patient status at admission to hospital and patient outcome. A likely explanation is the difficulty in retrieving all relevant...

The specific blocking of the axillary nerve has never been investigated clinically. We present four cases illustrating potential applications of the axillary nerve block in the perioperative setting and discuss possible directions for future research in this area. The axillary nerve blocks were all performed using a newly developed in-plane ultraso...

Sympathetic block causes vasodilatation and increases in skin temperature (T(s)). However, the T(s) response after specific nerve blocking is unknown. In this study, we hypothesized that T(s) would increase after specific blocking of the nerve innervating that area. Forty-six patients undergoing hand surgery were included. We performed ultrasound-g...

Chylomicronaemia syndrome is a rare disorder primarily caused by a genetic defect which increases triglycerides, combined with a secondary inducing factor. We describe the fatal course of a 33-year-old, pregnant woman with known dyslipidaemia who had been treated with in vitro fertilisation and developed chylomicronaemia syndrome with severe hypert...

In a rat model of chronic Pseudomonas aeruginosa lung infection mimicking cystic fibrosis, we investigated the possibility of preventing chronic lung inflammation or decreasing the progression of the infection. We compared the lethality, pathology, bacterial clearance, and immunogenicity after stimulation of the non-specific defence mechanisms by E...

We have previously shown that exercise-induced GH release is not mediated by ghrelin, but it remains to be studied whether the increase in GH may suppress postexercise ghrelin levels. The objective of this study was to characterize systemic ghrelin levels after exercise with and without concomitant GH administration. Group A: Twenty-nine elite athl...

The present study was designed as a randomized, double-blind placebo (Plc)-controlled study to determine the effect of 2 wk of growth hormone administration (GH-adm.) on energy expenditure (EE) and substrate oxidation in healthy humans. Sixteen young healthy men were divided into two groups. The study consisted of two 24-h measurements (indirect ca...

The purpose of this study was to examine the effects of increased fat availability induced by growth hormone (GH) administration on the oxidative metabolism during exercise. Seven well-trained males (age 25 +/- 2 years (mean +/- S.E.M.); peak oxygen consumption : 62 +/- 1 ml min(-1) kg(-1) (completed four randomised trials: 120 min bicycling at 55%...

Despite abundance of fat, exclusive dependency on fat oxidation can only sustain a metabolic rate corresponding to 50–60% of VO 2max in humans. This puzzling finding has been subject to intense research for many years. Lately, it has gained renewed interest as a consequence of increased obesity and physical inactivity imposed by Western lifestyle....

The expression of two isoforms of insulin-like growth factor-I (IGF-I): mechano growth factor (MGF) and IGF-IEa were studied in muscle in response to growth hormone (GH) administration with and without resistance training in healthy elderly men. A third isoform, IGF-IEb was also investigated in response to resistance training only. The subjects (ag...

The aim of the GH-2000 project is to develop a method for detecting GH doping among athletes. Previous papers in the GH-2000 project have proposed that a forthcoming method to detect GH doping will need specific components from the GH/IGF-I axis and bone markers because these specific variables seem more sensitive to exogenous GH than to exercise....

We studied the acute effects of a single, sc GH dose on exercise performance and metabolism during bicycling. Seven highly trained men [age, 26 ± 1 yr (mean ± sem); weight, 77 ± 3 kg; maximal oxygen uptake, 65 ± 1 ml O2·min−1·kg−1] performed 90 min of bicycling 4 h after receiving 7.5 IU (2.5 mg) GH or placebo in a randomized, double-blinded, cross...

Our objective was to study the effect of recombinant human growth hormone (rhGH) on hepatic cytochrome P450 (CYP) activity in 30 healthy elderly men. The study was carried out as a randomized, double-blind, placebo-controlled parallel-group study. rhGH or placebo was administered for a period of 12 weeks. CYP activity was measured before, after 12...

Subcutaneous adipose tissue lipolysis was studied in vivo by Fick's arteriovenous (a-v) principle using either calculated (microdialysis) or directly measured (catheterization) adipose tissue venous glycerol concentration. We compared results during steady-state (rest and prolonged continuous exercise), as well as during non-steady-state (onset of...

To characterize the lipolytic response in the subcutaneous abdominal adipose tissue in older women to endurance exercise. Cross-sectional exercise study. Exercise laboratory, Copenhagen, Denmark. Seven healthy, older women (mean age +/- standard error = 75 +/- 2 years); weight: 67.8 +/- 4.9 kg; body fat: 40 +/- 3; maximal oxygen uptake (VO2max): 1....

GH administration, either alone or combined with resistance exercise training (RT), has attracted interest as a means of increasing muscle mass and strength in the elderly. In the present study, 31 healthy, elderly men [age, 74 +/- 1 yr (mean +/- SEM)] were assigned to either RT [3 sessions/wk, 3-5 sets of 8-12 repetition maximum (RM)/session] + pl...

Background and objectives: GH administration results in increased lean body mass (LBM), decreased fat mass (FM) and increased energy expenditure (EE). GH therapy may therefore have potential benefits, especially in the elderly, who are known to have decreased function of the GH/IGF-I axis. Several studies have focused on effects of GH administrati...