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  1. Article ; Online: Real-Time Ultrasound-Guided Spinal Injection Using a Transverse In-Plane Dependent Technique: A Case Series.

    Sivakumar, Ranjith Kumar / Areeruk, Pornpatra / Mok, Louis Y H / Samy, Winnie / Karmakar, Manoj Kumar

    A&A practice

    2022  Volume 16, Issue 7, Page(s) e01596

    Abstract: Ultrasound-guided (USG) spinal injection is generally performed using a paramedian sagittal oblique scan, with the patient in the lateral decubitus position, and the spinal needle inserted in-plane from the nondependent side. This report evaluated the ... ...

    Abstract Ultrasound-guided (USG) spinal injection is generally performed using a paramedian sagittal oblique scan, with the patient in the lateral decubitus position, and the spinal needle inserted in-plane from the nondependent side. This report evaluated the feasibility of performing USG spinal injection, using an alternative transverse interspinous scan with in-plane needle insertion, a transverse in-plane dependent (TIPD) technique, in 30 adult patients undergoing elective surgery under spinal anesthesia. Dural puncture was successfully achieved in 29 of 30 (96.6%) patients with 2 (1-3) attempts in 5 (4-8) minutes using the TIPD technique. Multiple interspinous osteophytes accounted for technical failure in 1 patient.
    MeSH term(s) Adult ; Anesthesia, Spinal/methods ; Humans ; Injections, Spinal ; Needles ; Ultrasonography ; Ultrasonography, Interventional/methods
    Language English
    Publishing date 2022-07-11
    Publishing country United States
    Document type Journal Article
    ISSN 2575-3126
    ISSN (online) 2575-3126
    DOI 10.1213/XAA.0000000000001596
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Ultrasound-Guided Selective Trunk Block to Produce Surgical Anesthesia of the Whole Upper Extremity: A Case Report.

    Karmakar, Manoj Kumar / Areeruk, Pornpatra / Mok, Louis Y H / Sivakumar, Ranjith Kumar

    A&A practice

    2020  Volume 14, Issue 9, Page(s) e01274

    Abstract: None of the classical brachial plexus block techniques can reliably produce surgical anesthesia of the whole upper extremity that is from shoulder to hand. We describe ultrasound-guided "selective trunk block" (SeTB) that was successfully used to produce ...

    Abstract None of the classical brachial plexus block techniques can reliably produce surgical anesthesia of the whole upper extremity that is from shoulder to hand. We describe ultrasound-guided "selective trunk block" (SeTB) that was successfully used to produce surgical anesthesia of the whole ipsilateral upper extremity in a patient undergoing intramedullary nailing of the humerus for a pathological fracture. The 3 trunks of the brachial plexus were individually identified and selectively blocked with 2 separate injections. We conclude that SeTB is a viable option when surgical anesthesia of the whole upper extremity, except for the intercostobrachial nerve (T2) territory, is being considered.
    MeSH term(s) Brachial Plexus/diagnostic imaging ; Brachial Plexus Block ; Humans ; Ultrasonography ; Ultrasonography, Interventional ; Upper Extremity/diagnostic imaging ; Upper Extremity/surgery
    Language English
    Publishing date 2020-09-01
    Publishing country United States
    Document type Case Reports ; Journal Article
    ISSN 2575-3126
    ISSN (online) 2575-3126
    DOI 10.1213/XAA.0000000000001274
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Minimum effective volume of 0.5% ropivacaine for ultrasound-guided costoclavicular brachial plexus block: A dose finding study.

    Wong, Ming H / Karmakar, Manoj K / Mok, Louis Y H / Songthamwat, Banchobporn / Samy, Winnie

    European journal of anaesthesiology

    2020  Volume 37, Issue 9, Page(s) 780–786

    Abstract: Background: Costoclavicular brachial plexus block (CC-BPB) is a relatively new regional anaesthetic technique and there are no data on the minimum effective volume 90 (MEV90) of 0.5% ropivacaine required for an ultrasound-guided CC-BPB.: Objective: ... ...

    Abstract Background: Costoclavicular brachial plexus block (CC-BPB) is a relatively new regional anaesthetic technique and there are no data on the minimum effective volume 90 (MEV90) of 0.5% ropivacaine required for an ultrasound-guided CC-BPB.
    Objective: To determine the MEV90 of 0.5% ropivacaine required to produce surgical anaesthesia with an ultrasound-guided CC-BPB.
    Design: Prospective up-down sequential allocation study design.
    Setting: University teaching hospital in Hong Kong from March 2016 to December 2017.
    Patients: Forty-eight, ASA physical status I to III patients, aged 70 years or less and scheduled for elective forearm or hand surgery under an ultrasound-guided CC-BPB, were recruited.
    Intervention: Ultrasound-guided CC-BPB was performed with the assigned volume of 0.5% ropivacaine. The Dixon 'up-and-down' sequential allocation method using the biased coin design was used to determine the MEV90 of 0.5% ropivacaine. The assigned volume of ropivacaine was based on the outcome of the previous patient. After a block failure the next patient received a volume increase of 2 ml. If the block was a success, the next patient was allocated, with a probability of b = 0.11, to receive 2 ml less, or, with a probability of 1 - b = 0.89, the same volume.
    Main outcome measures: A successful block was defined as a minimum score of 14 of 16 points, using a composite sensory and motor block score at 45 min after the injection. The study was stopped when 45 successful blocks were achieved. MEV90 with 95% confidence interval was calculated using the centred isotonic regression for point and interval dose response studies.
    Results: The MEV90 of 0.5% ropivacaine for ultrasound-guided CC-BPB was 20.9 (95% confidence interval, 20.7 to 21.8) ml. The mean ± SD time to readiness for surgery was 31.4 ± 12.60 min.
    Conclusion: The MEV90 of 0.5% ropivacaine required to produce surgical anaesthesia with an ultrasound-guided CC-BPB is 20.9 ml.
    Clinical trial registration: The trial was registered with the Chinese Clinical Trials Registry (www.chictr.org.cn, ChiCTR-IOR-15007515, principal investigator: Manoj Kumar Karmakar, date of registration: 4 December 2015).
    Clinical trial number and registry url: ChiCTR-IOR-15007515, Chinese Clinical Trials Registry (www.chictr.org.cn).
    MeSH term(s) Aged ; Amides ; Anesthetics, Local ; Brachial Plexus/diagnostic imaging ; Brachial Plexus Block ; Humans ; Prospective Studies ; Ropivacaine ; Ultrasonography, Interventional
    Chemical Substances Amides ; Anesthetics, Local ; Ropivacaine (7IO5LYA57N)
    Language English
    Publishing date 2020-07-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 605770-6
    ISSN 1365-2346 ; 0265-0215
    ISSN (online) 1365-2346
    ISSN 0265-0215
    DOI 10.1097/EJA.0000000000001287
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Deep Parasternal Intercostal Plane Block for Intraoperative Pain Control in Cardiac Surgical Patients for Sternotomy: A Prospective Randomized Controlled Trial.

    Wong, Henry M K / Chen, P Y / Tang, Geoffrey C C / Chiu, Sandra L C / Mok, Louis Y H / Au, Sylvia S W / Wong, Randolph H L

    Journal of cardiothoracic and vascular anesthesia

    2023  Volume 38, Issue 3, Page(s) 683–690

    Abstract: Objectives: Sternotomy pain is common after cardiac surgery. The deep parasternal intercostal plane (DPIP) block is a novel technique that provides analgesia to the anterior chest wall. The aim of this study was to investigate the analgesic effect of ... ...

    Abstract Objectives: Sternotomy pain is common after cardiac surgery. The deep parasternal intercostal plane (DPIP) block is a novel technique that provides analgesia to the anterior chest wall. The aim of this study was to investigate the analgesic effect of bilateral DPIP blocks on intraoperative pain control in cardiac surgery.
    Design: This is a double-blinded, prospective randomized controlled trial (Oct 2020-Dec 2022).
    Settings: This study was conducted in a single institution, which is an academic university hospital.
    Participants: Eighty-six elective cardiac surgical patients with median sternotomy were recruited.
    Interventions: Patients were randomly divided into DPIP or control group. Either 20ml 0.25% levobupivacaine or 0.9% normal saline was injected for the DPIP under ultrasound guidance after induction of general anaesthesia.
    Measurements and main results: The primary outcome was intraoperative opioids consumption and hemodynamic changes at sternotomy. Secondary outcomes included postoperative morphine consumption, postoperative pain and time to tracheal extubation. Intraoperative opioids requirement was reduced from a median (IQR) intravenous morphine equivalence of 21.4mg (13.8-24.3mg) in control group to 9.5mg (7.3-11.2mg) in the DPIP group (P<0.001). Hemodynamic parameters were more stable in DPIP group at sternotomy, as evidenced by lower percentage increase in systolic, diastolic and mean arterial blood pressure from baseline. No difference was observed in time to tracheal extubation, postoperative morphine consumption, postoperative pain score and spirometry.
    Conclusions: Bilateral DPIP block provides effective intraoperative analgesia and opioid-sparing. It may be included as part of the multimodal analgesia for enhanced recovery in cardiac surgery.
    MeSH term(s) Humans ; Sternotomy/adverse effects ; Prospective Studies ; Nerve Block/methods ; Cardiac Surgical Procedures/methods ; Pain, Postoperative/diagnosis ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control ; Analgesics, Opioid ; Morphine ; Iopanoic Acid/analogs & derivatives
    Chemical Substances 1,3-dihydroxypropan-2-one 1,3-diiopanoate ; Analgesics, Opioid ; Morphine (76I7G6D29C) ; Iopanoic Acid (FE9794P71J)
    Language English
    Publishing date 2023-11-30
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2023.11.038
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 2203: Show issues Location:
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  5. Article ; Online: High-definition ultrasound imaging defines the paraneural sheath and fascial compartments surrounding the cords of the brachial plexus at the costoclavicular space and lateral infraclavicular fossa.

    Areeruk, Pornpatra / Karmakar, Manoj Kumar / Reina, Miguel A / Mok, Louis Y H / Sivakumar, Ranjith Kumar / Sala-Blanch, Xavier

    Regional anesthesia and pain medicine

    2021  Volume 46, Issue 6, Page(s) 500–506

    Abstract: Background and objectives: The paraneural sheath is a multilayered network of collagen fibers that surround the brachial plexus. Currently, there are no sonographic data on the paraneural sheath of the brachial plexus, which this study aimed to evaluate. ...

    Abstract Background and objectives: The paraneural sheath is a multilayered network of collagen fibers that surround the brachial plexus. Currently, there are no sonographic data on the paraneural sheath of the brachial plexus, which this study aimed to evaluate.
    Methods: Ultrasound imaging datasets of 100 patients who received a costoclavicular brachial plexus block, using high-definition ultrasound imaging, were retrospectively reviewed. Video files, representing sonograms before and after the local anesthetic injection, from the costoclavicular space and lateral infraclavicular fossa were collated and reviewed by three experienced anesthesiologists. Frequency (yes/no) of ultrasound visualization of the paraneural sheath, septum, and the anterior and posterior compartments was assessed. Representative sonograms from the costoclavicular space and lateral infraclavicular fossa were visually correlated with archived cadaver microanatomic sections from the same location.
    Results: Datasets of the 98 patients who achieved surgical anesthesia were evaluated. The paraneural sheath, septum, and the anterior and posterior compartments were visualized in 17.3%, 7.1%, 5.1% and 5.1%, respectively, at the costoclavicular space before the brachial plexus block; this contrasts (p<0.001) with their visibility post-block (94.9%, 75.5%, 75.5% and 75.5%, respectively). At the lateral infraclavicular fossa, the corresponding visibility of these structures post-block were 67.7%, 81.5%, 81.5% and 81.5%, respectively. Ultrasound images of the paraneural sheath and septum correlated well with that in the cadaver microanatomic sections.
    Conclusion: We have demonstrated the paraneural sheath and fascial compartments surrounding the cords of the brachial plexus at the costoclavicular space and lateral infraclavicular fossa using high-definition ultrasound imaging.
    Trial registration number: ClinicalTrials.gov Registry (NCT04370184), (https://www.clinicaltrials.gov/).
    Language English
    Publishing date 2021-04-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 1425299-5
    ISSN 1532-8651 ; 1098-7339 ; 0146-521X
    ISSN (online) 1532-8651
    ISSN 1098-7339 ; 0146-521X
    DOI 10.1136/rapm-2020-102304
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    Zs.B 2399: Show issues Location:
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  6. Article ; Online: Ultrasound-Guided Infraclavicular Brachial Plexus Block: Prospective Randomized Comparison of the Lateral Sagittal and Costoclavicular Approach.

    Songthamwat, Banchobporn / Karmakar, Manoj Kumar / Li, Jia Wei / Samy, Winnie / Mok, Louis Y H

    Regional anesthesia and pain medicine

    2018  Volume 43, Issue 8, Page(s) 825–831

    Abstract: Background and objectives: It has recently been proposed that an infraclavicular brachial plexus block (BPB) at the costoclavicular (CC) space may overcome some of the limitations of the lateral sagittal (LS) approach. In this study, we hypothesized ... ...

    Abstract Background and objectives: It has recently been proposed that an infraclavicular brachial plexus block (BPB) at the costoclavicular (CC) space may overcome some of the limitations of the lateral sagittal (LS) approach. In this study, we hypothesized that the CC approach will produce faster onset of sensory blockade of the 4 major terminal nerves of the brachial plexus than the LS approach.
    Methods: Forty patients undergoing elective upper extremity surgery under a BPB were randomized to receive either the LS (Gp-LS, n = 20) or CC approach (Gp-CC, n = 20) for infraclavicular BPB. Twenty-five milliliters of 0.5% ropivacaine was used for the BPB in both study groups. Sensory-motor blockade of the ipsilateral median, radial, ulnar, and musculocutaneous nerves was assessed by a blinded observer at regular intervals for 45 minutes after the block. Sensory block was assessed using a verbal rating scale (0-100) and motor block using a 3-point qualitative scale (0-2). Onset of sensory (primary outcome variable) and motor blockade was defined as the time it took to achieve a sensory verbal rating scale of 30 or less and motor grade of 1 or less, respectively. Time to readiness for surgery was defined as the time it took to achieve a sensory score of 30 or less and motor grade of 1 or less in all the 4 nerves tested.
    Results: The overall sensory onset time (median [interquartile range]) was significantly faster (P = 0.004) in Gp-CC (10 [10-26.25] minutes) than in Gp-LS (20 [15-30] minutes). The overall sensory score was significantly lower in Gp-CC than in Gp-LS at 5 (P < 0.001), 10 (P = 001), 15 (P = 0.001), and 20 (P = 0.04) minutes after the BPB. The overall motor score was significantly lower (P = 0.009) in Gp-CC than in Gp-LS at 10 minutes after the BPB. There were more (P = 0.04) patients with complete sensory-motor blockade at 20 minutes after the BPB in Gp-CC (25%) than in Gp-LS (0%). Time to readiness for surgery was also significantly faster (P = 0.002) in Gp-CC (10 [10-26.5] minutes) than in Gp-LS (20 [15-30] minutes).
    Conclusions: The CC approach for infraclavicular BPB produces faster onset of sensory blockade and earlier readiness for surgery than the LS approach.
    Clinical trial registration: This study was registered at the Centre for Clinical Trials of The Chinese University of Hong Kong, identifier CUHK_CCT00389.
    MeSH term(s) Adult ; Aged ; Brachial Plexus/diagnostic imaging ; Brachial Plexus/surgery ; Brachial Plexus Block/methods ; Brachial Plexus Block/standards ; Clavicle/diagnostic imaging ; Clavicle/surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Single-Blind Method ; Ultrasonography, Interventional/methods ; Ultrasonography, Interventional/standards
    Language English
    Publishing date 2018-06-20
    Publishing country England
    Document type Comparative Study ; Journal Article ; Randomized Controlled Trial
    ZDB-ID 1425299-5
    ISSN 1532-8651 ; 1098-7339 ; 0146-521X
    ISSN (online) 1532-8651
    ISSN 1098-7339 ; 0146-521X
    DOI 10.1097/AAP.0000000000000822
    Database MEDical Literature Analysis and Retrieval System OnLINE

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