The Study of Regional Hemodynamic Changes After Specific Brachial Plexus Block by Ultrasound Guidance

Summary

Phase 1 Sympathetic block leads to vasodilatation and increases in blood flow. However, regional hemodynamic changes of radial and ulnar artery after specific nerve block of brachial plexus remains unclear. The aim of the study is to assess the effect of specific nerve block of brachial plexus on hemodynamics of upper extremity, and provides evidence for further research in patient undergoing microvascular surgery. Phase 2 There is no literature about dose-finding studies of sympathetic block after brachial plexus block. Little is known regarding the relationship between concentration of local anaesthetic and vasodilation of upper extremity. The aim of this randomized, double-blind, prospective dose-response study is to determine the ED50 and ED95 of ropivacaine in sympathetic block of upper extremity after supraclavicular block

Timeline

Start

2011-01

Primary completion

2012-12

Completion

2012-12

Publications

• Background Li J, Karmakar MK, Li X, Kwok WH, Ngan Kee WD. Regional hemodynamic changes after an axillary brachial plexus block: a pulsed-wave Doppler ultrasound study. Reg Anesth Pain Med. 2012 Jan-Feb;37(1):111-8. doi: 10.1097/AAP.0b013e318234007e.
• Background Shemesh D, Olsha O, Orkin D, Raveh D, Goldin I, Reichenstein Y, Zigelman C. Sympathectomy-like effects of brachial plexus block in arteriovenous access surgery. Ultrasound Med Biol. 2006 Jun;32(6):817-22. doi: 10.1016/j.ultrasmedbio.2006.02.1420.
• Background Hermanns H, Braun S, Werdehausen R, Werner A, Lipfert P, Stevens MF. Skin temperature after interscalene brachial plexus blockade. Reg Anesth Pain Med. 2007 Nov-Dec;32(6):481-7. doi: 10.1016/j.rapm.2007.06.392.
• Background Sahin L, Gul R, Mizrak A, Deniz H, Sahin M, Koruk S, Cesur M, Goksu S. Ultrasound-guided infraclavicular brachial plexus block enhances postoperative blood flow in arteriovenous fistulas. J Vasc Surg. 2011 Sep;54(3):749-53. doi: 10.1016/j.jvs.2010.12.045. Epub 2011 Mar 2.
• Background Hingorani AP, Ascher E, Gupta P, Alam S, Marks N, Schutzer RW, Multyala M, Shiferson A, Yorkovich W, Jacob T, Salles-Cunha S. Regional anesthesia: preferred technique for venodilatation in the creation of upper extremity arteriovenous fistulae. Vascular. 2006 Jan-Feb;14(1):23-6. doi: 10.2310/6670.2006.00006.
• Background Breschan C, Kraschl R, Jost R, Marhofer P, Likar R. Axillary brachial plexus block for treatment of severe forearm ischemia after arterial cannulation in an extremely low birth-weight infant. Paediatr Anaesth. 2004 Aug;14(8):681-4. doi: 10.1111/j.1460-9592.2004.01282.x.
• Background Ebert B, Braunschweig R, Reill P. [Quantification of variations in arm perfusion after plexus anesthesia with color doppler sonography]. Anaesthesist. 1995 Dec;44(12):859-62. doi: 10.1007/s001010050222. German.
• Background Badal JJ, Kiesau A, Boyle P. Effects of median nerve block on radial artery diameter and peak velocity. Local Reg Anesth. 2010;3:5-10. doi: 10.2147/lra.s9524. Epub 2010 Feb 23.
• Background Van der Werff JF, Medici G, Hovius SE, Kusuma A. Axillary plexus blockade in microvascular surgery, a steal phenomenon? Microsurgery. 1995;16(3):141-3. doi: 10.1002/micr.1920160305.
• Background Sonntag BV, Murphy RX Jr, Chernofsky MA, Chowdary RP. Microvascular steal phenomenon in lower extremity reconstruction. Ann Plast Surg. 1995 Mar;34(3):336-9; discussion 339-40. doi: 10.1097/00000637-199503000-00020.
• Background Lange KH, Jansen T, Asghar S, Kristensen PL, Skjonnemand M, Norgaard P. Skin temperature measured by infrared thermography after specific ultrasound-guided blocking of the musculocutaneous, radial, ulnar, and median nerves in the upper extremity. Br J Anaesth. 2011 Jun;106(6):887-95. doi: 10.1093/bja/aer085. Epub 2011 Apr 6.
• Background Lehtipalo S, Winso O, Koskinen LO, Johansson G, Biber B. Cutaneous sympathetic vasoconstrictor reflexes for the evaluation of interscalene brachial plexus block. Acta Anaesthesiol Scand. 2000 Sep;44(8):946-52. doi: 10.1034/j.1399-6576.2000.440809.x.
• Background Morgan RF, Reisman NR, Wilgis EF. Anatomic localization of sympathetic nerves in the hand. J Hand Surg Am. 1983 May;8(3):283-8. doi: 10.1016/s0363-5023(83)80161-0.
• Background Campero M, Verdugo RJ, Ochoa JL. Vasomotor innervation of the skin of the hand: a contribution to the study of human anatomy. J Anat. 1993 Jun;182 ( Pt 3)(Pt 3):361-8.
• Background Kurt E, Ozturk S, Isik S, Zor F. Continuous brachial plexus blockade for digital replantations and toe-to-hand transfers. Ann Plast Surg. 2005 Jan;54(1):24-7. doi: 10.1097/01.sap.0000139568.57928.86.
• Background van den Berg B, Berger A, van den Berg E, Zenz M, Brehmeier G, Tizian C. [Continuous plexus anesthesia to improve circulation in peripheral microvascular interventions]. Handchir Mikrochir Plast Chir. 1983 Jun;15(2):101-4. German.
• Background Fredrickson MJ, Smith KR, Wong AC. Importance of volume and concentration for ropivacaine interscalene block in preventing recovery room pain and minimizing motor block after shoulder surgery. Anesthesiology. 2010 Jun;112(6):1374-81. doi: 10.1097/ALN.0b013e3181d6929d.
• Background Casati A, Baciarello M, Di Cianni S, Danelli G, De Marco G, Leone S, Rossi M, Fanelli G. Effects of ultrasound guidance on the minimum effective anaesthetic volume required to block the femoral nerve. Br J Anaesth. 2007 Jun;98(6):823-7. doi: 10.1093/bja/aem100. Epub 2007 May 3.
• Background Gupta PK, Pace NL, Hopkins PM. Effect of body mass index on the ED50 volume of bupivacaine 0.5% for supraclavicular brachial plexus block. Br J Anaesth. 2010 Apr;104(4):490-5. doi: 10.1093/bja/aeq017. Epub 2010 Feb 18.
• Li T, Ye Q, Wu D, Li J, Yu J. Dose-response studies of Ropivacaine in blood flow of upper extremity after supraclavicular block: a double-blind randomized controlled study. BMC Anesthesiol. 2017 Dec 2;17(1):161. doi: 10.1186/s12871-017-0447-7.
• Li T, Ye Q, Yeung J, Wu D, Li J, Lian Q, Gao F. Regional haemodynamic changes after selective block of the four principal nerves in the arm: A double-blind randomised controlled study. Eur J Anaesthesiol. 2016 Aug;33(8):599-601. doi: 10.1097/EJA.0000000000000433. No abstract available.

Drugs

Indications

No indication recorded.