Single or double-injection technique in axillary block: the success of motor and sensor blockade

Background and Purpose: Axillary brachial plexus block is the method of choice for surgical procedures of upper arm except shoulder region. Distribution of local anaesthetic toward neurovascular space may be a reason for failed block. We investigated the axillary block effectiveness by singeand double-injection technique. Materials and Methods: Ninety patients (21–81 old; ASA I-IV) scheduled for upper arm surgery were divided in three equal groups during prospective, double-blind study. Nerve position was located with neurostimulator (Stimuplex® HNS 11)(0.5 mA, 2Hz and 0.1 ms). In Group S (single-shot), mixture of 30 mL (15 mL 0.5% bupivacaine and 15 mL 2% lidocaine) was injected only above axillary artery (25 mL around median and 5 mL around musculocutaneus nerve). In Group U and R (double-shot), the same mixture of local anaesthetic was applied above (10 mL around median and 5 mL around musculocutaneus nerve) and below axillary artery (15 mL around radial or ulnar nerve). Motor and sensor block were determined (Bromage scale, Pinprick method). Statistic analysis was done (SSP11.0). Results and Conclusions: Effective block analgesia and anaesthesia was achieved in shorter time in Group R (18+/4 and 26+/–3 min)(Group U: 34+/–4 and 41+/–3 min, Group S: 35+/–4 and 45+/–2 min) (P=0.0000) (Table 2). Block effectiveness was significantly higher after radial nerve stimulation (92%)(Group U 88% and S 76%) (P=0.630). Faster motor block was achieved in Group R (18+/–4)(Group U 26+/–3 and S 35+/–4 min) (P=0.000). Double-shot technique with primar radial nerve stimulation, allows better motor and sensor axillary block in comparison with single-shot technique

Comparation of early continuous epidural and intravenous opioid analgesia on haemodynamic changes after several pelvic fractures

Background and Purpose: Continuous epidural analgesia improves excellent pain control in trauma patients with multiple pelvic fractures. Rezidual haemodynamic instability followed by retroperitoneal hemorrhagie in the first 48 hours often post-pones its application with need for parenteral use of high dose of opioids. The aim was to compere the influence of early continuous epidural and intravenous opioid analgesia on haemodynamic changes in these patients. Materials and Methods: After Ethic Committee approval, fifty trauma patients with isolated multiple pelvic fractures were divided in two equal groups and included in prospective, randomized study. In bought groups initial analgesia was started with sufentanil 10 μg h–1 in the first 24h. After that, in Group EP continuous epidural analgesia (levibupivacain O.125%, 5–7 mL h–1) and in Group O continuous infusion of opioid (sufentanil 5–10 μg h–1) was started. The analgesics dose was titrated following the VAS score under 3. PICCO monitoring was established. MAP, CI, HR, SVRI, ITBVI and ELWI was measured during four days. Statistic analysis was done by SPSS 11.0. Results: Study groups were statistic comparable. In the first 24 hours during continuous opioid anaesthesia, bought groups had high need for fluid replacement (Group EP=3.2 ± 0.3, Group O=3.0 ± 0.5 L/24h) (P=0.0928). Second day, SVRI was lower in O Group (1300–1520; EP Group=1700–1810)(P=0.0243) and recovered with 500–750mLof crystalloids infusion. ITBVI was statistical more stable inGroup EP (950 ± 50; Group O (1100 ± 30)(P=0.0002). Only 10% of patients with low CI (<3.0) in Group EP (Group O=32%) needed catecholamin support. Conclusion: Early continuous epidural analgesia with 0.125% levibupivacain is safe as continuous opioid analgesia in patients with multiple pelvic fractures but without opioids complications and better haemodynamic stability

Single or double-injection technique in axillary block: the success of motor and sensor blockade

Background and Purpose: Axillary brachial plexus block is the method of choice for surgical procedures of upper arm except shoulder region. Distribution of local anaesthetic toward neurovascular space may be a reason for failed block. We investigated the axillary block effectiveness by singeand double-injection technique. Materials and Methods: Ninety patients (21–81 old; ASA I-IV) scheduled for upper arm surgery were divided in three equal groups during prospective, double-blind study. Nerve position was located with neurostimulator (Stimuplex® HNS 11)(0.5 mA, 2Hz and 0.1 ms). In Group S (single-shot), mixture of 30 mL (15 mL 0.5% bupivacaine and 15 mL 2% lidocaine) was injected only above axillary artery (25 mL around median and 5 mL around musculocutaneus nerve). In Group U and R (double-shot), the same mixture of local anaesthetic was applied above (10 mL around median and 5 mL around musculocutaneus nerve) and below axillary artery (15 mL around radial or ulnar nerve). Motor and sensor block were determined (Bromage scale, Pinprick method). Statistic analysis was done (SSP11.0). Results and Conclusions: Effective block analgesia and anaesthesia was achieved in shorter time in Group R (18+/4 and 26+/–3 min)(Group U: 34+/–4 and 41+/–3 min, Group S: 35+/–4 and 45+/–2 min) (P=0.0000) (Table 2). Block effectiveness was significantly higher after radial nerve stimulation (92%)(Group U 88% and S 76%) (P=0.630). Faster motor block was achieved in Group R (18+/–4)(Group U 26+/–3 and S 35+/–4 min) (P=0.000). Double-shot technique with primar radial nerve stimulation, allows better motor and sensor axillary block in comparison with single-shot technique