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Background: Intravenous regional anesthesia (IVRA) and the axillary brachial plexus block are popular alternatives to general anaesthesia in ambulatory hand surgery. Although both have proven their effectiveness, patients' preferences have never been evaluated.
Objectives: We investigated patient satisfaction with both techniques and hypothesised that satisfaction after IVRA is noninferior compared with axillary brachial plexus block.
Design: A prospective, randomised controlled trial.
Setting: Ambulatory surgical day care centre, University Hospitals of Leuven, Belgium, from September 2016 to November 2017.
Patients: One hundred and twenty adults undergoing minor ambulatory hand surgery were included in this study.
Intervention: Patients received either IVRA with 300 mg lidocaine or an axillary block with 280 mg mepivacaine.
Main Outcome Measures: The primary endpoint was the evaluation of patient satisfaction using the 'Evaluation du Vécu de l'Anésthesie Locoregional' (EVAN-LR) questionnaire. Secondary outcomes included different procedural times, block quality, tourniquet discomfort, the incidence of block failure and postoperative nausea and vomiting (PONV), the severity of postoperative pain and the need for postoperative analgesics during the first 24 h.
Results: Noninferiority of IVRA was shown for the median [IQR] total score on the EVAN-LR questionnaire, IVRA-group: 92 [87 to 96] vs. axillary brachial plexus block-group: 91[87 to 97]; Hodges--Lehmann estimator (95% confidence interval (CI)] for the shift: -0.25 (-2.60 to 2.20). Induction of anaesthesia and time to discharge, requiring partial recovery of the motor block, were significantly longer in the axillary brachial plexus block group. The IVRA-group had a lower block quality, a higher incidence of tourniquet-discomfort and higher median intra-operative and postoperative pain scores on day 0; 0 [0 to 2] vs. 0 [0 to 0] and 0.8 [0 to 1.8] vs. 0 [0 to 0.25], respectively, but no increase in the need for supplementary analgesics or conversion rate to general anaesthesia.
Conclusion: IVRA and axillary brachial plexus block result in comparably high patient satisfaction in ambulatory hand surgery.
Clinical Trial Registration: EudraCT 2016-002325-11.
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http://dx.doi.org/10.1097/EJA.0000000000001259 | DOI Listing |
Indian J Radiol Imaging
January 2025
Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
Takayasu arteritis (TA) is a form of large vessel vasculitis that may lead to fibrosis, stenosis, or aneurysm formation of vessels. Its presentation varies depending on the arterial beds involved. We report 3 cases out of around 150 cases of TA with rare initial presentations of brachial plexopathy caused by an axillary artery aneurysm, complicated type A intramural hematoma, and renal artery aneurysms along with abdominothoracic TA presenting as a pulsatile abdominal mass.
View Article and Find Full Text PDFJ Clin Med
December 2024
Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 61-545 Poznań, Poland.
Damage to the upper trunk of the brachial plexus, often caused by high-energy trauma, leads to significant functional impairment of the upper limb. This injury primarily affects the C5 and C6 roots, resulting in paralysis of muscles critical for shoulder and elbow function. If spontaneous nerve regeneration does not occur within 3-6 months post-injury, surgical intervention, including nerve transfers, is recommended to restore function.
View Article and Find Full Text PDFCureus
November 2024
Department of General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND.
A schwannoma is a benign, solitary, noninvasive, and encapsulated tumor that originates from Schwann cells of the peripheral nerve sheath commonly found in the head and neck. A rare case of a benign schwannoma in the axillary region of a 34-year-old male patient is presented here accompanied by a discussion on the known entities of peripheral nerve schwannoma as well as the clinical and radiological findings coupled with treatment techniques. The patient presented with a left axillary mass of seven years gradually progressing in size which is associated with pain in the left arm.
View Article and Find Full Text PDFFolia Morphol (Warsz)
December 2024
Nicolaus Copernicus University in Toruń, Toruń, Poland.
Background: In this study, we described the anatomy of the brachial plexus of the guinea pig (Cavia porcellus). The description of the brachial plexus anatomy can contribute to the knowledge of the neuroanatomy of small mammals. Furthermore, it is a source of information for clinicians performing brachial plexus anesthesia in exotic animals such as the guinea pig (Cavia porcellus).
View Article and Find Full Text PDFSurg Radiol Anat
December 2024
Department of Anatomy, School of Medicine, University of Barcelona, Barcelona, Spain.
Purpose: Knowledge of a large communication between posterior circumflex humeral and deep brachial arteries, although infrequent, it is important to avoid damage during a Leechavengvongs procedure or used as recipient artery in free flaps for upper limb reconstruction.
Methods: A dissection of a latex-injected cadaver revealed the presence of a large communication between the posterior circumflex humeral and deep brachial arteries. Furthermore, this communicating artery was observed during a Leechavengvongs procedure.
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