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A Case of Horner's Syndrome following Ultrasound-Guided Infraclavicular Brachial Plexus Block
Trabelsi Walid,Belhaj Amor Mondher,Lebbi Mohamed Anis,Ferjani Mustapha
Case Reports in Anesthesiology , 2012, DOI: 10.1155/2012/125346
Abstract: Horner’s syndrome results from paralysis of the ipsilateral sympathetic cervical chain (stellate ganglion) caused by surgery, drugs (mainly high concentrations of local anesthetics), local compression (hematoma or tumor), or inadequate perioperative positioning of the patient. It occurs in 100% of the patients with an interscalene block of the brachial plexus and can also occur in patients with other types of supraclavicular blocks.In this case report, we presented a case of Horner’s syndrome after performing an ultrasound-guided infraclavicular brachial plexus block with 15 mL of bupivacaine 0.5%. It appeared 40 minutes after the block with specific triad (ptosis, miosis, and exophtalmia) and quickly disappears within 2 hours and a half without any sequelae. Horner's syndrome may be described as an unpleasant side effect because it has no clinical consequences in itself. For this reason anesthesiologists should be aware of this syndrome, and if it occurs patients should be reassured and monitored closely.
A Case of Horner's Syndrome following Ultrasound-Guided Infraclavicular Brachial Plexus Block  [PDF]
Trabelsi Walid,Belhaj Amor Mondher,Lebbi Mohamed Anis,Ferjani Mustapha
Case Reports in Anesthesiology , 2012, DOI: 10.1155/2012/125346
Abstract: Horner’s syndrome results from paralysis of the ipsilateral sympathetic cervical chain (stellate ganglion) caused by surgery, drugs (mainly high concentrations of local anesthetics), local compression (hematoma or tumor), or inadequate perioperative positioning of the patient. It occurs in 100% of the patients with an interscalene block of the brachial plexus and can also occur in patients with other types of supraclavicular blocks.In this case report, we presented a case of Horner’s syndrome after performing an ultrasound-guided infraclavicular brachial plexus block with 15?mL of bupivacaine 0.5%. It appeared 40 minutes after the block with specific triad (ptosis, miosis, and exophtalmia) and quickly disappears within 2 hours and a half without any sequelae. Horner's syndrome may be described as an unpleasant side effect because it has no clinical consequences in itself. For this reason anesthesiologists should be aware of this syndrome, and if it occurs patients should be reassured and monitored closely. 1. Introduction Horner’s syndrome may correspond to a diffusion of local anesthetics in prevertebral spaces ultimately involving the sympathetic nerves and communicating with cervical nerve trunks [1]. It results from paralysis of the ipsilateral sympathetic cervical chain (stellate ganglion) caused by surgery, drugs (mainly high concentrations of local anesthetics), local compression (hematoma or tumor), or inadequate perioperative positioning of the patient [2, 3]. Interscalene and supraclavicular blocks of the brachial plexus are the main anesthetic techniques associated with this syndrome [4–6]. 2. Case Report After her written consent, a 52-year-old healthy woman (74?kg, 168?cm), classified as American Society of Anesthesiologists physical status I (with a medical history of subtotal thyroidectomy under cervicotomy), was scheduled for carpal tunnel syndroms surgery under tourniquet device. Perioperative anesthesia consisted of an ultrasound-guided infraclavicular brachial plexus block. No premedications were applied to the case. An intravenous cannula was inserted into the contralateral arm, and a continuous infusion (crystalloid solution) was started. For the whole procedure the patient was routinely monitored with electrocardiogram (ECG), noninvasive blood pressure (NIBP) measurement, and pulse oximetry (SpO2). The patient was in supine position, with the head facing away from the side to be anesthetized, and the arm were adducted and flexed at the elbow and resting over the chest or upper abdomen. Following the positioning, the area on the
Lateral approach for supraclavicular brachial plexus block  [cached]
Sahu D,Sahu Anjana
Indian Journal of Anaesthesia , 2010,
Abstract: A lateral approach described by Volker Hempel and Dr. Dilip Kotharihas been further studied, evaluated and described in detail in the present study. The aim of this study was to evaluate lateral approach of supraclavicular brachial plexus block, mainly in terms of successes rate and complication rate. The study was conducted in secondary level hospital and tertiary level hospital from 2004 to 2008. It was a prospective nonrandomized open-level study. Eighty-two patients of both sexes, aged between 18 and 65 years with ASA Grade I and II scheduled to undergo elective major surgery of the upper limb below the midarm, were selected for this new lateral approach of brachial plexus block. The onset and duration of sensory and motor block, any complications and need for supplement anaesthesia were observed. Success and complication rate were calculated in percentage. Average onset and duration of sensory and motor block was calculated as mean ± SD and percentage. Out of 82 patients, 75 (92%) have got successful block with no significant complication in any case.
Buprenorphine as an adjuvant in supraclavicular brachial plexus block.  [cached]
Amol Prakash Singam,Ashok Chaudhari,Manda Nagrale
International Journal of Biomedical and Advance Research , 2012, DOI: 10.7439/ijbar.v3i7.511
Abstract: ABSTRACT Background & Aims: Brachial plexus block is a useful alternative to general anaesthesia. Postoperative analgesia is an added advantage. Buprenorphine, an agonist antagonist opioid has been used by various routes to prolong analgesia. The present study was undertaken to assess the analgesic efficacy of Buprenorphine with Bupivacaine in brachial plexus block. Methods: A prospective, randomized, double blind study was done on 60 adult patients of ASA 1 and 2, aged between 18-50 years and scheduled for various upper limb surgeries. Patients were divided into two groups of 30 each. Group C (control group) received 38ml of inj. bupivacaine 0.25% +2ml normal saline and group B (Buprenorphine group) received 38ml of inj. bupivacaine 0.25% +2ml inj. Buprenorphine (preservative free) (0.3 mg). Patients were observed for onset and duration of motor block, onset and duration of sensory block , duration of pain relief and occurrence of any complications. Results: Post operative analgesia was significantly longer (901.33 ±60.04 min) in group B, as compared to group C (343.00 ±33.02 min) with p value <0.001. Duration of sensory block in group C was 322.16 ±31.80 min and in group B 647.83 ±55.70 min. with p value <0.001. Pain score was significantly low in group B (mean 1.44), compared to group C (mean 5.60) at 12 hours postoperatively. Conclusion: Addition of Buprenorphine 0.3 mg to 38ml of bupivacaine 0.25% for supraclavicular brachial plexus block prolonged sensory blockade and post-operative analgesia without increasing the risk of adverse effects.
Extraordinary prolonged blockade following supraclavicular brachial plexus block with bupivacaine.
Jagdish Dureja,Nandita Kad,Jatin Lal,Anil Thakur
Indian Anaesthetists' Forum , 2009,
Abstract: Brachial plexus block is a useful anaesthetic technique for the upper limb surgery using Bupivacaine hydrochloride as anaesthetic agent for the block. A case of extraordinary prolonged block after administration of 0.375 % plain bupivacaine by the supraclavicular route is reported.
Ultrasound-guided supraclavicular brachial plexus block in patient with halo device  [cached]
Delvi Mohamed
Saudi Journal of Anaesthesia , 2010,
Abstract: Ultrasound guided regional blocks are on the rise, many institutes are training their staff to master this technique of regional anesthesia. Regional anesthesia in case of an emergency surgery or elective surgery can be the best choice. The case described here is an example - patient with a halo fixation device after motor vehicle accident scheduled for surgery of the extremity. The main aim of management of this case is to achieve a safe anesthesia with minimal interference of the cervical fixation. Supraclavicular brachial plexus block is a good choice for surgeries of the arm and hand and use of an ultrasound to guide the block adds to the safety profile of this versatile block. It has been described as "Spinal of the upper limb". Patients with co-morbidities and injuries to the cervical spine are challenging cases to anesthetize, as regional anesthesia is a very attractive option, failure of the regional block will expose the patient to all adverse sequelae, which were being avoided by planning for a regional anesthesia. Ultrasound has revolutionized the way regional anesthesia is practiced and the proper drug can be placed at the right place in the hands of an experienced anesthesiologist and the block will help in avoiding all the complications of endotracheal anesthesia in these cases.
Comparison of two approaches of infraclavicular brachial plexus block for orthopaedic surgery below mid-humerus  [cached]
Trehan Vikas,Srivastava Uma,Kumar Aditya,Saxena Surekha
Indian Journal of Anaesthesia , 2010,
Abstract: The brachial plexus in infraclavicular region can be blocked by various approaches. Aim of this study was to compare two approaches (coracoid and clavicular) regarding success rate, discomfort during performance of block, tourniquet tolerance and complications. The study was randomised, prospective and observer blinded. Sixty adult patients of both sexes of ASA status 1 and 2 requiring orthopaedic surgery below mid-humerus were randomly assigned to receive nerve stimulator guided infraclavicular brachial plexus block either by lateral coracoid approach (group L, n = 30) or medial clavicular approach (group M, n = 30) with 25-30 ml of 0.5% bupivacaine. Sensory block in the distribution of five main nerves distal to elbow, motor block (Grade 1-4), discomfort during performance of block and tourniquet pain were recorded by a blinded observer. Clinical success of block was defined as the block sufficient to perform the surgery without any supplementation. All the five nerves distal to elbow were blocked in 77 and 67% patients in groups L and M respectively. Successful block was observed in 87 and 73% patients in groups L and M, respectively (P > 0.05). More patients had moderate to severe discomfort during performance of block due to positioning of limb in group M (14 vs. 8 in groups M and L). Tourniquet was well tolerated in most patients with successful block in both groups. No serious complication was observed. Both the approaches were equivalent regarding success rate, tourniquet tolerance and safety. Coracoid approach seemed better as positioning of operative limb was less painful, coracoids process was easy to locate and the technique was easy to learn and master.
Infraclavicular Brachial Plexus Blockade in a Case with Ulnar Shaft Fracture
Mehmet Turan Inal,Canan Inal,Sermet Inal
Trakya Universitesi Tip Fakultesi Dergisi , 2008,
Abstract: The brachial plexus is a peripheral nerve system that is responsible for motor, sympathetic and sensorial innervations of upper extremity. Brachial plexus lies between neck and shoulder next to great vessels and lungs. The anesthesia of upper extremities and shoulder can be achieved by blockade of brachial plexus in different places. Brachial plexus can be blocked using interscalene, supraclavicular, infraclavicular and axillary methods. In this case report, we presented an infraclavicular brachial plexus blockade for a patient with ulnar shaft fracture.
Effect of Nalbuphine as Adjuvant to Bupivacaine for Ultrasound-Guided Supraclavicular Brachial Plexus Block  [PDF]
Mohamed Mohamed Abdelhaq, Mohamed Adly Elramely
Open Journal of Anesthesiology (OJAnes) , 2016, DOI: 10.4236/ojanes.2016.63004
Abstract: Background: Nalbuphine is a derivative of 14-hydroxymorphine which is a strong analgesic with mixed k agonist and μ antagonist. Nalbuphine was studied several times as adjuvant to local anesthetics in spinal, epidural and local intravenous block. The aim of this study was to evaluate the effect of nalbuphine as an adjuvant to local anesthetics in supraclavicular brachial plexus block. Patients and Methods: Fifty-six patients undergoing elective forearm and hand surgery under supraclavicular brachial plexus block were allocated randomly into one of two groups of 28 patients each to receive either 25 ml (0.5%) bupivacaine with 1 ml of NS or 25 ml (0.5%) bupivacaine with 1 ml (20 mg) nalbuphine. Onset time and duration of both sensory and motor block, and post-operative analgesia were observed. Result: Nalbuphine group showed significant increase in the duration of motor block (412.59 ± 18.63), when compared to control group (353.70 ± 29.019) p-value < 0.001, also, there was significant increase in sensory duration in nalbuphine group (718.14 ± 21.04) when compared to control group (610.18 ± 26.33) p-value < 0.001, without affecting the onset time of the blockade. And also, there was a significant increase in the duration of analgesic effect in nalbuphine group (835.18 ± 42.45) when compared to control group (708.14 ± 54.57) p-value < 0.001. Conclusion: The present study demonstrates that addition of 20 mg nalbuphine to bupivacaine in supraclavicular brachial plexus block is associated with significant increase in the duration of both sensory and motor block and also prolong the duration of analgesia.
The effect of low serum bicarbonate values on the onset of action of local anesthesia with vertical infraclavicular brachial plexus block in patients with End-stage renal failure  [cached]
Al-mustafa Mahmoud,Massad Islam,Alsmady Moaath,Al-qudah Abdullah
Saudi Journal of Kidney Diseases and Transplantation , 2010,
Abstract: Vertical infraclavicular brachial plexus block is utilized in patients with chronic renal failure at the time of creation of an arterio-venous fistula (AVF). The aim of this study is to test the effect of impaired renal function, with the resulting deranged serum electrolytes and blood gases, on the success rate and the onset of action of the local anesthetics used. In this prospective clinical study, we investigated the effect of the serum levels of sodium, potassium, urea, crea-tinine, pH, and bicarbonate on the onset of action of a mixture of lidocaine and bupivacaine administered to create infraclavicular brachial plexus block. A total of 31 patients were studied. The success rate of the block was 93.5 % (29 patients). The mean onset time for impaired or re-duced sensation was found to be 8.9 ± 4.7 mins and for complete loss of sensation, was 21.2 ± 6.7 mins. There was no significant association with serum sodium, potassium, urea, creatinine or the blood pH level (P> 0.05). The bivariate correlation between serum bicarbonate level and the partial and complete sensory loss was -0.714 and -0.433 respectively, with significant correlation (P= 0.00, 0.019). Our study suggests that infraclavicular block in patients with chronic renal failure carries a high success rate; the onset of the block is delayed in patients with low serum bicarbonate levels.
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