New composite scale for evaluating peripheral nerve block quality in upper limb orthopaedics surgery
Autor: | Róbert Almási, Balázs Patczai, Lajos Bogár, Edina Kovacs, Barbara Rezman, N. Wiegand |
---|---|
Rok vydání: | 2020 |
Předmět: |
Adult
medicine.medical_specialty Peripheral nerve block Upper Extremity 03 medical and health sciences 0302 clinical medicine Patient satisfaction Anesthesia Conduction medicine Humans Peripheral Nerves Anesthetics Local General Environmental Science 030222 orthopedics Pain Postoperative business.industry 030208 emergency & critical care medicine Brachial Plexus Block Surgery Upper limb surgery medicine.anatomical_structure Orthopedics Orthopedic surgery General Earth and Planetary Sciences Upper limb Midazolam business Trauma surgery Brachial plexus medicine.drug |
Zdroj: | Injury. 52 |
ISSN: | 1879-0267 |
Popis: | Developments in ultrasound guided (UG) peripheral nerve block (PNB) techniques have significant advantages for patients undergoing trauma surgery. Brachial plexus blockade (BPB) for upper extremity surgery provide superior analgesia, improve recovery and patient satisfaction. To the best of our knowledge there is no tool for evaluation of the quality of UG PNB which concerns the quality of PNB, the tolerance of the patient towards the anaesthetic approach, and postoperative analgesia as well.Standardized UG BPB anaesthesia - was performed; interscalene-supraclavicular (ISC-SC) and axillary-supraclavicular (AX-SC) approach for upper limb surgery. A GCS like tool was developed with which the Sensory, Motor, Coping of patient and Postoperative (SMCP) pain qualities were measured. The quality of PNBs were evaluated by a quality of anaesthesia graded by anaesthesiologist (QAGA) and the SMCP scale as well, the means of midazolam and opioid consumption during surgery, vital parameters, postoperative pain intensity (VNRS) were compared between the two groups.Ninety three unpremedicated adult patients with ASA I-III were scheduled for unilateral upper limb surgery. Nearly the same mean volumes of local anaesthetic solution were used in the AX-SC and ISC-SC groups (28.3-31.0 ml). There were no significant difference in the quality of PNB measured by QAGA or SMCP scale between the AX-SC and the ISC-SC groups, however 75 patients were assessed as Excellent with the SMCP scale vs. 39 with the QAGA. 97.8% of the patients were in the Excellent and Good category evaluated with SMPC vs. 86% with QAGA (p 0.001). There was no surgery abandoned due to failed PNB and no tourniquet pain was detected. There was no evidence of side effects or complications of PNB during the follow-up period.This composite tool is designed for evaluating the loss of sensory and motor function; the coping of the patient and the postoperative pain as well. Our novel SMCP evaluation tool focuses on the overall condition of the patient during surgery and in the postoperative period. This more precise outcome evaluating scale is significantly superior to the formerly used QAGA in representing the high success rate of UG PNB. |
Databáze: | OpenAIRE |
Externí odkaz: |