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IMPROVING SAFETY OF INTERSCALENE BRACHIAL PLEXUS BLOCK:THE TRIPLE MONITORING
ESRA Academy. Pascarella G. Sep 8, 2016; 138404
Topic: Safety of Regional Anaesthesia - Complications - General Aspects
Dr. Giuseppe Pascarella
Dr. Giuseppe Pascarella

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Abstract
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Background and Aims:

Nerve injury with neurologic dysfunction is a feared, although uncommon, complication of peripheral nerve blockade as it may result in permanent disability.
The aim of this study was to test the effectiveness and safety of a triple monitoring (TM), i.e. a combination of ultrasounds (US), nerve stimulation (NS) and opening injection pressure (OIP), during interscalene brachial plexus block (BPB). Fig.1

The triple monitoring
Methods:

Twenty patients undergoing interscalene BPB for shoulder arthroscopy received TM.
BSmart®, a single-use inline injection device connected to a 10 mL syringe, was used to detect OIP during interscalene BPB. The injection pressure was shown in colour-coded ranges provided by the piston.
Local anaesthetic was injected under US guidance between C5 and C6 roots. TM was performed according to the flowchart showed in Fig. 2.

Flowchart for triple monitoring

Data collection included the duration of block, the ability of US, NS and OIP to detect the needle-nerve contact, the presence of any pain during injection and the persistence of neurologic dysfunction at 24 h and at 1 month postoperatively.

Ethics Commette Approval
Results:

The mean duration of interscalene BPB was 68 seconds.
Needle-nerve contact was detected with NS in 6/20 patients despite the first control with US, whereas BSmart® detected more than 15 PSI (positive for needle-nerve contact) in 5/20 patients, despite a negative response of NS. Neither pain during injection nor postoperative neurologic dysfunctions were detected.


Conclusions:

Ultrasounds, opening injection pressure and nerve stimulation are synergistic and additive, allowing the optimal placement of needle tip during injection.
Triple monitoring is fast to perform and improves interscalene brachial plexus block safety and patient comfort.

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