Biomedical subjects

J Brems

Publications and source records attributed to J Brems.

21 records · Page 2Linked to original sources

PubMedDate not supplied

Interscalene brachial plexus block for shoulder surgery.

BACKGROUND AND OBJECTIVES: To evaluate the efficacy of interscalene brachial plexus block as the primary anesthetic for shoulder surgery, the influence on blood loss, and the rate of complication. METHODS: Retrospective review of 676 reconstructive surgical procedures of the shoulder for anesthetic technique (regional or general), regional anesthetic technique (paresthesia versus nerve stimulator), local anesthetic agent selected, success rate, estimated blood loss by procedures, and complications. RESULTS: A total of 563 patients had interscalene anesthesia, exclusively, and 117 had general anesthesia. Mepivacaine, 1.4% with 1/200,000 epinephrine, was the most frequently used agent (480). Others included 0.5% bupivacaine (33) and 0.625% bupivacaine (50). Of 563 interscalene blocks attempted, 34 required general anesthesia to either initiate or complete the surgery (success rate, 94.1%) with 20 in the 0.5% bupivacaine group, 10 in the mepivacaine group, and 9 in the 0.65% bupivacaine group. For blood loss calculations, failed interscalene blocks were included with the general anesthesia group. Three surgical procedures were identified: total shoulder arthroplasty, acromioplasty with and without repair of the rotator cuff, and capsular advancement for recurrent shoulder dislocation. Comparing general and interscalene anesthesia, blood loss was less in the overall group and in the acromioplasty-rotator cuff group when interscalene block was compared to general anesthesia. There were four complications with two seizures and two subdural injections. CONCLUSIONS: Interscalene anesthesia is an effective anesthetic for elective shoulder surgery that may decrease intraoperative blood loss with a low complication rate.

Anesthesia, Conduction↗

PubMedDate not supplied

Subdural anesthesia as a complication of an interscalene brachial plexus block. Case report.

BACKGROUND AND OBJECTIVES: Interscalene brachial plexus block is performed in the groove between the anterior and middle scalene muscles at the level of C6, just over the transverse process. Injection occurs within 1-2 cm of the dural sleeve and could be misdirected into the epidural, subdural, or subarachnoid spaces. METHODS: Interscalene block was performed by elicitation of paresthesia with 40 mL 1.4% mepivacaine, 1/200,000 epinephrine. RESULTS: Initially, complete interscalene block was achieved that evolved into apnea, high motor, and sensory block; requiring induction of general anesthesia. CONCLUSIONS: The case represents a partial injection of local anesthetic intended for the interscalene brachial plexus into the subdural space. The diagnosis is based on the normal evolution of the block into full motor and sensory anesthesia of the ipsilateral brachial plexus that evolved into a patchy, sensory, and motor block involving many dermatomes outside the brachial plexus, with minimal sympathetic block, and evidence of a normal interscalene block on emergence from general anesthesia. Subdural injection must be considered when unusual motor and sensory block occurs after interscalene block, especially after a time interval too long for epidural or subarachnoid injection, or with minimal evidence of sympathetic block, after suspected high central block injection.

Adult↗

PubMedDate not supplied

Patient acceptance of interscalene block for shoulder surgery.

BACKGROUND AND OBJECTIVES: Regional anesthesia can be applied to shoulder surgery with an expected high success rate. To determine the level of patient satisfaction with regional anesthesia, we studied a group of patients who had undergone shoulder surgery more than once, with general anesthesia on one occasion and regional on another. METHODS: Twenty-five consecutive patients with prior shoulder surgery under general anesthesia (GA) willing to receive interscalene brachial plexus anesthesia (ISB) were identified. On postoperative day one, a questionnaire was administered. Data were evaluated with McNemar's test and chi-square analysis and considered significant at p < 0.05. RESULTS: There were no differences in sedation or patient preparation between GA and ISB. ISB was tolerable during placement, and no patients complained of being aware or inadequately sedated. With ISB, there was better recovery room pain control, less nausea, and less vomiting. Overall, the patients preferred ISB. CONCLUSIONS: Interscalene brachial plexus block is well accepted by patients for reconstructive shoulder surgery.

Anesthesia, Conduction↗