Internal Jugular Vein Cannulation: An Ultrasound-Guided Technique Versus a Landmark-Guided Technique

OBJECTIVES: To compare the landmark-guided technique versus the ultrasound-guided technique for internal jugular vein cannulation in spontaneously breathing patients. METHODS: A total of 380 patients who required internal jugular vein cannulation were randomly assigned to receive internal jugular vein cannulation using either the landmark- or ultrasound-guided technique in Bursa, Uludag University Faculty of Medicine, between April and November, 2008. Failed catheter placement, risk of complications from placement, risk of failure on first attempt at placement, number of attempts until successful catheterization, time to successful catheterization and the demographics of each patient were recorded. RESULTS: The overall complication rate was higher in the landmark group than in the ultrasound-guided group (p < 0.01). Carotid puncture rate and hematoma were more frequent in the landmark group than in the ultrasound-guided group (p < 0.05). The number of attempts for successful placement was significantly higher in the landmark group than in the ultrasound-guided group, which was accompanied by a significantly increased access time observed in the landmark group (p < 0.05 and p < 0.01, respectively). Although there were a higher number of attempts, longer access time, and a more frequent complication rate in the landmark group, the success rate was found to be comparable between the two groups. CONCLUSION: The findings of this study indicate that internal jugular vein catheterization guided by real-time ultrasound results in a lower access time and a lower rate of immediate complications

Bloqueio dos nervos ílio‐hipogástrico/ilioinguinal em correção de hérnia inguinal para tratamento da dor no pós‐operatório: comparação entre a técnica de marcos anatômicos e a guiada por ultrassom

ResumoObjetivoComparar a eficácia de bloqueios dos nervos ílio‐hipogástrico/ilioinguinal feitos com a técnica guiada por ultrassom e a de marcos anatômicos para o manejo da dor no pós‐operatório em casos de herniorrafia inguinal em adultos.MétodosForam randomicamente divididos 40 pacientes, estado físico ASA I‐II, em dois grupos iguais: nos grupos AN (técnica de marcos anatômicos) e US (técnica guiada por ultrassom), o bloqueio dos nervos ílio‐hipogástrico/ilioinguinal foi feito com 20mL de levobupivacaína a 0,5% antes da cirurgia com as técnicas especificadas. Escore de dor na avaliação pós‐operatória, tempo de primeira mobilização, tempo de internação hospitalar, escore de satisfação com a analgesia no pós‐operatório, efeitos colaterais induzidos por opiáceos e complicações relacionadas ao bloqueio foram avaliados durante 24horas de pós‐operatório.ResultadosEscores EVA em repouso na sala de recuperação e todos os valores clínicos durante o acompanhamento foram significativamente menores no grupo ultrassom (p<0,01 ou p<0,001). Escores EVA em movimento na sala de recuperação e todos os valores clínicos durante o acompanhamento foram significativamente menores no grupo ultrassom (p<0,001 em todos os tempos avaliados). Enquanto os tempos de internação e da primeira mobilização foram significativamente menores, os índices de satisfação com a analgesia foram significativamente maiores no grupo ultrasom (p<0,05, p<0,001, p<0,001, respectivamente).ConclusãoDe acordo com o nosso estudo, o bloqueio dos nervos ílio‐hipogástrico/ilioinguinal guiado por US em herniorrafias inguinais em adultos proporciona uma analgesia mais eficaz e maior satisfação com a analgesia do que com a técnica de marcos anatômicos. Além disso, pode‐se sugerir que a observação das estruturas anatômicas com a US pode aumentar o sucesso do bloqueio e minimizar as complicações relacionadas ao bloqueio.AbstractObjectivesThe purpose of this study is to compare the efficacy of iliohypogastric/ilioinguinal nerve blocks performed with the ultrasound guided and the anatomical landmark techniques for postoperative pain management in cases of adult inguinal herniorrhaphy.Methods40 patients, ASA I–II status were randomized into two groups equally: in Group AN (anatomical landmark technique) and in Group ultrasound (ultrasound guided technique), iliohypogastric/ilioinguinal nerve block was performed with 20ml of 0.5% levobupivacaine prior to surgery with the specified techniques. Pain score in postoperative assessment, first mobilization time, duration of hospital stay, score of postoperative analgesia satisfaction, opioid induced side effects and complications related to block were assessed for 24h postoperatively.ResultsVAS scores at rest in the recovery room and all the clinical follow‐up points were found significantly less in Group ultrasound (p<0.01 or p<0.001). VAS scores at movement in the recovery room and all the clinical follow‐up points were found significantly less in Group ultrasound (p<0.001 in all time points). While duration of hospital stay and the first mobilization time were being found significantly shorter, analgesia satisfaction scores were found significantly higher in ultrasound Group (p<0.05, p<0.001, p<0.001 respectively).ConclusionAccording to our study, US guided iliohypogastric/ilioinguinal nerve block in adult inguinal herniorrhaphies provides a more effective analgesia and higher satisfaction of analgesia than iliohypogastric/ilioinguinal nerve block with the anatomical landmark technique. Moreover, it may be suggested that the observation of anatomical structures with the US may increase the success of the block, and minimize the block‐related complications

Axillary Brachial Plexus Blockage in Treatment of Upper Extremity Ischemic Disorder in Critically Ill Patient: A Report of Two Cases

Arterial catheterization, vasoactive agents, autonomic dysfunction and septic embolus may cause ischemia at distal ends of upper extremity in critically ill patients. Axillary brachial plexus blockage is highly reliable intervention when appropriate technique is used. Sympathetic blockage occurs after administration of local anesthetic drug and can resolve the circulatory disorder of extremity. We aimed to present two cases with ischemia of upper distal extremity that resolves after axillary brachial plexus blockage

Intrathecal morphine in anesthesia for cesarean delivery: dose-response relationship for combinations of low-dose intrathecal morphine and spinal bupivacaine

Study objective: To evaluate the quality of analgesia and the severity of side effects of intrathecal morphine administered for a dose range of 0.0 to 0.4 mg for postcesarean analgesia with low-dose bupivacaine

The Combination of Low-dose Levobupivacaine and Fentanyl for Spinal Anaesthesia in Ambulatory Inguinal Herniorrhaphy

This study investigated whether the addition of 25 mu g intrathecal fentanyl to levobupivacaine spinal anaesthesia for outpatient inguinal herniorrhaphy allows a sub-anaesthetic levobupivacaine dose to be used. Forty patients were assigned to receive 5 mg levobupivacaine 0.5% mixed with 25 mu g fentanyl (group LF) or 7.5 mg levobupivacaine 0.5% (group L). The highest sensory block levels achieved were T7 (range T5 - T9) and T6 (range T4 - T9) in groups LF and L, respectively. The times to two-segment regression, S2 regression, ambulation, urination and discharge were all significantly shorter in group LF than group L. These results indicate that, for outpatient inguinal herniorrhaphy, intrathecal fentanyl combined with low-dose levobupivacaine provides good quality spinal anaesthesia and minimizes the need for intra-operative analgesia. This protocol is well suited for the outpatient setting because it features rapid recovery of full motor power, sensory function and bladder function

Conscious Sedation for Endoscopic Retrograde Cholangiopancreatography: Dexmedetomidine Versus Midazolam

Objective: Midazolam and dexmedetomidine, which are used for sedation during endoscopic retrograde cholangiopancreatography, were compared to evaluate the differences in efficacy, hemodynamics, and side effects. Materials and Methods: Fifty patients aged between 18 and 80 were randomly assigned to two groups according to American Society of Anesthesiologists (ASA) classification: Group M received midazolam with an initial bolus infusion of 0.04 mg/kg intravenously (i.v.), followed by additional doses of 0.5 mg i.v. midazolam, titrated to achieve a Ramsay sedation scale score of 3-4. Group D received dexmedetomidine with an initial bolus infusion of 1 mcg/kg/hr i.v. over 10 minutes, followed by a continuous infusion of 0.2-0.7 mcg/kg/hr, titrated to achieve an RSS of 3-4. A Mini Mental Status Examination (MMSE) was performed prior to sedation and in the recovery room once the Modified Aldrete Score (MAS) reached 9-10. Patient heart rates, arterial pressure and pain were evaluated. Results: Patients in Group D had lower heart rates at 20, 25, 30, 35 and 40 minutes following the initiation of sedation (p0.05). When patient and surgeon satisfaction was compared between the two groups, Group D showed higher surgeon satisfaction scores (p<0.05). Conclusion: The use of dexmedetomidine for conscious sedation during short, invasive procedures, such as endoscopic retrograde cholangiopancreatography, could be a superior alternative to the use of midazolam

Iliohypogastric/ilioinguinal nerve block in inguinal hernia repair for postoperative pain management: comparison of the anatomical landmark and ultrasound guided techniques

Objectives:The purpose of this study is to compare the efficacy of iliohypogastric/ilioinguinal nerve blocks performed with the ultrasound guided and the anatomical landmark techniques for postoperative pain management in cases of adult inguinal herniorrhaphy.Methods:40 patients, ASA I-II status were randomized into two groups equally: in Group AN (anatomical landmark technique) and in Group ultrasound (ultrasound guided technique), iliohypogastric/ilioinguinal nerve block was performed with 20 ml of 0.5% levobupivacaine prior to surgery with the specified techniques. Pain score in postoperative assessment, first mobilization time, duration of hospital stay, score of postoperative analgesia satisfaction, opioid induced side effects and complications related to block were assessed for 24 h postoperatively.Results:VAS scores at rest in the recovery room and all the clinical follow-up points were found significantly less in Group ultrasound (p < 0.01 or p < 0.001). VAS scores at movement in the recovery room and all the clinical follow-up points were found significantly less in Group ultrasound (p < 0.001 in all time points). While duration of hospital stay and the first mobilization time were being found significantly shorter, analgesia satisfaction scores were found significantly higher in ultrasound Group (p < 0.05, p < 0.001, p < 0.001 respectively).Conclusion:According to our study, US guided iliohypogastric/ilioinguinal nerve block in adult inguinal herniorrhaphies provides a more effective analgesia and higher satisfaction of analgesia than iliohypogastric/ilioinguinal nerve block with the anatomical landmark technique. Moreover, it may be suggested that the observation of anatomical structures with the US may increase the success of the block, and minimize the block-related complications