Ultrasound-guided training in the performance of brachial plexus block by the posterior approach: an observational study.

The application of ultrasonography in guiding and controlling the path of the stimulating needle to the brachial plexus via the posterior approach (Pippa technique) was studied. In 21 ASA physical status 1 and 2 patients, scheduled for surgery of the shoulder or upper arm, needle insertion was monitored by ultrasonography and the interaction between needle, surrounding structures and brachial plexus was followed. During injection, the spread of local anaesthetic was visualised and a prediction of block success was made. One failure was predicted. Complete block was achieved in 20 (95%) patients. One potential complication, puncture of the carotid artery, was prevented using ultrasound. Ultrasound is a useful tool in the training and performance of a neurostimulation-guided brachial plexus block by the posterior approach. Ultrasonographic guidance may prevent serious complications associated with this approach to the brachial plexus.

A comparison of the vertical infraclavicular and axillary approaches for brachial plexus anaesthesia.

BACKGROUND: This prospective, randomized study compared the efficacy of the vertical infraclavicular and axillary approaches using a single injection blockade of the brachial plexus. The primary endpoint was complete blockade in dermatomes C5-Th1, while secondary endpoints included onset time, motor block, block performance time, surgical success rate, patient satisfaction, and side-effects/complications. METHODS: Sixty patients, American Society of Anesthesiologists physical status I or II, scheduled for surgery of the forearm or hand received either a vertical infraclavicular (n = 30) or an axillary block (n = 30). A single injection of 0.5 ml/kg ropivacaine 7.5 mg/ml was made after electrolocalization of nerve fibres corresponding to the median nerve at maximum 0.5 mA (2 Hz, 0.1 ms). Onset and distribution of analgesia and motor block were assessed at 5, 10, 15, 20, 30 and 60 min after the local anaesthetic injection. A complete block was defined as analgesia in all dermatomes (C5-Th1) at 60 min post-injection. RESULTS: The vertical infraclavicular approach provided complete blockade in 29 patients (97%) and the axillary approach in 23 patients (77%). Analgesia in C5-C6 dermatomes and corresponding motor block occurred significantly more frequently in the vertical infraclavicular approach, which also had the shortest onset time. Block procedure was quicker in the axillary approach. Side-effects were similar in both groups, and there were no permanent sequelae. Patient satisfaction was equally high in both groups. CONCLUSION: The vertical infraclavicular approach provides a more complete block than the axillary approach when using a single injection technique and equal volumes/doses of local anaesthetic.

Effects of hypnotics on sleep and psychomotor performance. A double-blind randomised study of lormetazepam, midazolam and zopiclone.

Lormetazepam, midazolam and zopiclone were compared as night medication in patients scheduled for elective surgery the next morning. Sixty patients divided at random into three groups, received double-blind lormetazepam 1 mg, midazolam 15 mg or zopiclone 7.5 mg, by mouth at 2200 hours. The quality of sleep was assessed at 0700 hours from responses to a questionnaire, and psychomotor function by comparing paper and pencil (p-deletion) and Maddox Wing tests with reference values from the day before. The three hypnotics were equally effective as sleep medication for time until onset of sleep, duration of sleep and condition upon awakening, whereas zopiclone provided significantly fewer (p less than 0.05) spontaneous awakenings. The p-deletion test did not differ in any of the three groups from the reference values. The ocular imbalance test in all three groups was significantly different (p less than 0.01) from control. The lormetazepam group scored significantly better (p less than 0.05) than the zopiclone group. No side effects were seen.