[Show abstract][Hide abstract] ABSTRACT: In an axillary brachial plexus block (ABPB), where relatively large doses of local anesthetics are administered, levobupivacaine is preferred due to a greater margin of safety. However, the efficacy of levobupivacaine in ABPB has not been studied much. We performed a prospective, double-blinded study to compare the clinical effect of 0.375% levobupivacaine with 0.5% levobupivacaine for ultrasound (US)-guided ABPB with nerve stimulation.
FORTY PATIENTS UNDERGOING ELECTIVE UPPER LIMB SURGERY WERE RANDOMIZED INTO TWO GROUPS: Group I (0.375% levobupivacaine) and Group II (0.5% levobupivacaine). All four main terminal nerves of the brachial plexus were blocked separately with 7 ml of levobupivacaine using US guidance with nerve stimulation according to study group. A blinded observer recorded the onset time for sensory and motor block, elapsed time to be ready for surgery, recovery time for sensory and motor block, quality of anesthesia, patient satisfaction and complications.
There were no significant differences in the time to find nerve locations, time to perform block and number of skin punctures between groups. Insufficient block was reported in one patient of Group I, but no failed block was reported in either group. There were no differences in the onset time for sensory and motor block, elapsed time to be ready for surgery, patient satisfaction and complications.
0.375% levobupivacaine produced adequate anesthesia for ABPB using US guidance with nerve stimulation, without any clinically significant differences compared to 0.5% levobupivacaine.
Preview · Article · Jan 2012 · Korean journal of anesthesiology
[Show abstract][Hide abstract] ABSTRACT: Femoral vein (FV) catheterization is required for critically ill patients, patients with difficult peripheral intravenous access, and patients undergoing major surgery. The purpose of this study was to evaluate the effects of hip abduction with external rotation (frog-leg position), and the frog-leg position during the reverse Trendelenburg position on diameter, cross-sectional area (CSA), exposed width and ratio of the FV using ultrasound investigation.
Ultrasonographic FV images of 50 adult subjects were obtained: 1) in the neutral position (N position); 2) in the frog-leg position (F position); 3) in the F position during the reverse Trendelenburg position (FRT position). Diameter, CSA, and exposed width of the FV were measured. Exposed ratio of the FV was calculated.
The F and FRT positions increased diameter, CSA and exposed width of the FV significantly compared with the N position. However, the F and FRT positions had no significant effect on exposed ratio of the FV compared with the N position. The FRT position was more effective than the F position in increasing FV size.
The F and FRT positions can be used to increase FV size during catheterization. These positions may increase success rate and reduce complication rate and, therefore, can be useful for patients with difficult central venous access or at high-risk of catheter-related complication.
Preview · Article · Sep 2011 · Korean journal of anesthesiology