CENTRUM
ANESTHESIE ARTIKELS ABSTRACT 1 Incidence of iatrogenic pneumothorax after ultrasound guided supraclavicular nerve block for upper limb surgery: a single centre experience of 3641 blocks. Vandemoortele O, Helsloot D, Van Belleghem V, Desmet M, et al. European Journal of Anaesthesiology, 2020, 37, 113
incidence of pneumothorax has been reported in recent years to be decreased by the use of ultrasound. Incidences lower than 0.05% have been reported (1). Our data indicate that real incidence could be even lower.
CONCLUSION Retrospective analysis of 3641 ultrasound guided supraclavicular nerve blocks indicate that this is a safe procedure and confirm previous studies indicating that the overall incidence of pneumothorax is very low (< 0.05 %).
INTRODUCTION An ultrasound guided supraclavicular nerve block is one of several anaesthesia techniques to perform anaesthesia and postoperative analgesia for upper limb surgery. However, the presence of the subclavian artery and pleural cavity in the vicinity of the brachial plexus results in a possible risk for hematoma and pneumothorax. The incidence of iatrogenic pneumothorax after a supraclavicular nerve block without ultrasound is reported to vary between 0.5 and 6 percent. However, the overall incidence of pneumothorax diminishes with increasing experience and is further reduced with the use of ultrasound to an overall incidence of 0.05%.
OBJECTIVE This audit aims to demonstrate the incidence of iatrogenic pneumothorax after ultrasound guided supraclavicular nerve block in a high volume centre.
MATERIALS/METHODS A retrospective analysis was performed on all supraclavicular nerve blocks for upper limb surgery in our hospital between January 1, 2016 and November 31, 2019. All supraclavicular nerve blocks were performed at the discretion of the attending anaesthesiologist. The overall incidence of clinically significant pneumothorax (suspected by symptoms of dyspnea or chest pain following the performance of the block and confirmed by chest X-ray) was documented.
ABSTRACT 2 Implementation of regional anesthesia guidelines in clinical practice, does it happen in real life? Desmet M, Missant C, Reynvoet M, Lamote S et al. European Journal of Anaesthesiology, 2020, 37, 114
INTRODUCTION Clinical practice often lags behind evidence presented in the literature. Current guidelines advocate the use of low volumes of local anesthetics during peripheral nerve blocks (PNB), accept the safety of PNB performance under general anesthesia (GA) and recommend the use of combining ultrasound (US) and nerve stimulation (NS) during PNB.
OBJECTIVE This audit aims to evaluate if clinical practice has changed according to guidelines.
MATERIALS/METHODS An audit was performed on all supraclavicular (SCB) and interscalene blocks (ISB) for upper limb surgery executed in a single centre in 201 6and 2019. All blocks were performed at the discretion of the attending anesthesist. Statistical analysis using Student’s t tests and Chi square tests was performed onthe volume used, the combined use of US and NS and the performance of PNB under sedation or GA.
RESULTS Between 01-01-2016 and 31-11-2019, 3641 supraclavicular nerve blocks were performed for upper limb surgery. All blocks were performed using ultrasound. 2870 blocks were performed by graduated anaesthesiologists with a variable expertise in regional anaesthesia. 771 were performed by residents. No cases of a clinically significant pneumothorax could be identified in our database. Supraclavicular nerve blocks provide excellent analgesia for upper limb surgery and are frequently used for day case surgery. Accidental pleural puncture and pneumothorax could however delay hospital discharge and increase hospital costs. The overall
RESULTS In 2016 and 2019, 828 and 886 SCB were performed.There was a significant reduction of the mean volume used from 35 to 26mL (p<0.05). In 2016 both US and NS was used in 76% of cases where in 2019 this was only 37% (p<0.05). Only a small minority of patients received a PNB under GA (4 in 2016, 5 in 2019), there was a significant reduction in the use of sedatives from 2016 to 2019 (90% in 2016 vs 15% in 2019, p<0.05). In 2016 and 2019, 576 and 645 ISB were performed. There was no difference in the volume used
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