Interscalene bracheal plexus block has became a popular method of anesthesia for surgical operation on the upper extremities. Possible complications are subarachnoid block, epidural block, phrenic nerve block, vagus or recurrent laryngeal nerve block, sympathetic nerve block, intravascular injection. But reported complications has been few and generally without prolonged effects. The following describes a patient who developed signs and symptoms suggestive of inadvertent phrenic nerve block and epidural anesthesia as complications of interscalene bracheal plexus block The complications were attributed to using of inferomedially directed 5 cm needle and then additional blind block of the brachial plexus with 5 or 6 times. We emphasize that if the appropriate length of needle and technique are not used, phrenic nerve paralysis and serious complications including total spinal or epidural block can occur as a result of a medially misdirected needle.
Anesthesia ; Anesthesia, Epidural ; Autonomic Nerve Block ; Brachial Plexus ; Humans ; Needles ; Paralysis* ; Phrenic Nerve* ; Recurrent Laryngeal Nerve ; Upper Extremity

Blocks of the ganglion impar are used to treat both malignant and benign causes of visceral and sympathetic pelvic and perineal pain. While conventionally done under fluoroscopic guidance, significant improvements in transducer technology in the past decade have piqued the interest and enthusiasm of interventional pain specialists toward ultrasound-guided performance. In the setting of a pandemic, it is important to ensure the efficacy of treatment as well as the safety of both patients and health care workers. This paper presents two patients who underwent two approaches of ultrasound-guided ganglion impar blocks in a tertiary government hospital in the Philippines during the COVID-19 pandemic.

More than 80% of cancer-related pain is pharmacologically controllable, whereas 10~20% of patients require interventional treatments. Neurolytic nerve block can play a major role in cancer pain treatment, and it has been proposed to prevent the development of pain and improve the quality of life of patients with cancer. If the pain is well localized and restricted to certain peripheral parts of the body, spinal peripheral or sympathetic nerve blocks may result in excellent therapeutic effects. Neurolytic sympathetic block, especially Celiac plexsus block (CPB) performed in earlier stages, is effective with successful long term results. However, selection of patients is critical for succeful outcomes. Neurolytic plexus block significantly improves the quality of life of patients and reduces abdominal and pelvic cancer pain, analgesic consumption and adverse opioids-related side effects. Interventional pain management should be considered at earlier stages to provide patients with the best quality of life possible.
Autonomic Nerve Block ; Humans ; Nerve Block ; Pain Management ; Pelvic Neoplasms ; Quality of Life

BACKGROUND: Infraclaviculr Brachial plexus (ICBP) block is useful for upper extremity surgery. The aim of this study was to compare the ultrasound (US) technique with the nerve stimulation (NS) technique in their success rates and times to perform ICBP block. METHODS: 60 patients undergoing surgery of the upper limb were randomly allocated into two groups (n = 30 per group). Group 1; US, and Group 2; NS. Procedure time (including time for initial ultrasound examination), the success rate and the onset time of sensory and motor blockade were assessed. RESULTS: The time needed to perform the ICBP block is similar in both groups (220 seconds +/- 130 in US group versus 281 +/- 134 seconds in NS group; P = 0.74). The success rate of all the nerve blocks in the US group was 100%. The success rate in the NS group was 73.3%, 76.7%, 76.7% and 100% for radial, ulnar, medial, and musculocutaneous nerve, respectively. A significantly faster onset of sensory block for the radial, ulnar, median, musculocutaneous, and the four nerves considered together were observed. The onset of motor block for the radial, ulnar, and medial nerves was faster in the US group. However, the onset of motor block for the musculocutaneous nerve and the four nerves considered together was comparable between the two groups. CONCLUSIONS: The ultrasound-guided infraclavicular brachial plexus block is a significantly efficacious method with faster onset but similar procedure time compared to the nerve stimulation technique.
Brachial Plexus ; Bupivacaine ; Humans ; Musculocutaneous Nerve ; Nerve Block ; Upper Extremity

Chronic pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain regardless of its etiology. Sympathetic nerve block is effective and safe for treatment of pelvic visceral pain. One of them, the inferior hypogastric plexus, is not easily assessable to blockade by local anesthetics and neurolytic agents. Inferior hypogastric plexus block is not commonly used in chronic pelvic pain patients due to pre-sacral location. Therefore, inferior hypogastric plexus is not readily blocked using paravertebral or transdiscal approaches. There is only one report of inferior hypogastric plexus block via transsacral approach. This approach has several disadvantages. In this case a favorable outcome was obtained by using coccygeal transverse approach of inferior hypogastric plexus. Thus, we report a patient who was successfully given inferior hypogastric plexus block via coccygeal transverse approach to treat chronic pelvic pain conditions involving the lower pelvic viscera.
Anesthetics, Local ; Autonomic Nerve Block ; Humans ; Hypogastric Plexus ; Nerve Block ; Pelvic Pain ; Sympathetic Nervous System ; Viscera ; Visceral Pain

Lymphedema of the upper limb after breast cancer surgery is a disease that carries a life-long risk and is difficult to cure once it occurs despite the various treatments which have been developed. Two patients were referred from general surgery department for intractable lymphedema. They were treated with stellate ganglion blocks (SGBs), and the circumferences of the mid-point of their each upper and lower arms were measured on every visit to the pain clinic. A decrease of the circumference in each patient was observed starting after the second injection. A series of blocks were established to maintain a prolonged effect. Both patients were satisfied with less swelling and pain. This case demonstrates the benefits of an SGB for intractable upper limb lymphedema.
Arm ; Autonomic Nerve Block ; Breast Neoplasms* ; Humans ; Lymphedema* ; Mastectomy ; Nerve Block ; Pain Clinics ; Stellate Ganglion* ; Upper Extremity

This study analyzed the effects of treatment by stellate ganglion block, epidural block and intercostal block on 34 patients suffering from herpes zoster and postherpetic neuralgia at the Division of Pain Clinic, Department of Anesthesiology, Chonnam National University Hospital during the last two years. 1) The freguency of occurrence the frequency of sex and the lesion side, right or left side of the trunk, were similar in all patients. 2) The most frequent age of incidence was between 50 and 70 years old (62%) 3) The most frequent site of lesions was the thorax (55%) 4) The earlier the treatment and the younger the patients were, the more satisfactory were the results of the nerve blocks. 5) Sympathetic nerve block, stellate ganglion and epidural blocks were more effective than somatic nerve blocks or intercostal blocks. 6) There was no relationship between the number of nerve blocks and the effect of the treatement.
Aged ; Anesthesiology ; Autonomic Nerve Block ; Herpes Zoster ; Humans ; Incidence ; Jeollanam-do ; Nerve Block ; Neuralgia, Postherpetic* ; Pain Clinics ; Stellate Ganglion ; Thorax

This study analyzed the effects of treatment by stellate ganglion block, epidural block and intercostal block on 34 patients suffering from herpes zoster and postherpetic neuralgia at the Division of Pain Clinic, Department of Anesthesiology, Chonnam National University Hospital during the last two years. 1) The freguency of occurrence the frequency of sex and the lesion side, right or left side of the trunk, were similar in all patients. 2) The most frequent age of incidence was between 50 and 70 years old (62%) 3) The most frequent site of lesions was the thorax (55%) 4) The earlier the treatment and the younger the patients were, the more satisfactory were the results of the nerve blocks. 5) Sympathetic nerve block, stellate ganglion and epidural blocks were more effective than somatic nerve blocks or intercostal blocks. 6) There was no relationship between the number of nerve blocks and the effect of the treatement.
Aged ; Anesthesiology ; Autonomic Nerve Block ; Herpes Zoster ; Humans ; Incidence ; Jeollanam-do ; Nerve Block ; Neuralgia, Postherpetic* ; Pain Clinics ; Stellate Ganglion ; Thorax

With prolonged life expectancy and economic development, most people want a good quality of life. In this regard, the pain control becomes an important part in the medical care in addition to the treatment of the disease per se. Anesthesiologists have been practicing pain medicine for decades, with the unique application of specific nerve blocks. Pain clinic is a specialized department for pain management. The main therapeutic modality practiced at pain clinics in Korea is the nerve block. Nerve block is performed by an injection of an anesthetic or destructive substance hear a nerve or nerve plexus to interrupt its function for a brief or extended period, respectively. Nerve blocks play an important role in diagnosis, prognosis, and treatment of chronic pain. Nerve block intercepts the vicious cycle of pain as well as takes off the pain. Moreover, by improving the local blood flow, it also has an indirect effect on the treatment of pain. Sympathetic nerve block is used not only for pain relief, but also for the treatment of disease mainly accompanying sympathetic hyperactive symptoms. Pain clinic manages several kinds of intractable chronic pain. The rise in the number of pain clinics increases awareness of chronic pain with a considerable impact on our society.
Autonomic Nerve Block ; Chronic Pain ; Diagnosis ; Economic Development ; Korea ; Life Expectancy ; Nerve Block ; Pain Clinics* ; Pain Management* ; Prognosis ; Quality of Life

OBJECTIVE: To compare the effects of ultrasound-guided interscalene brachial plexus block and C5-6 nerve root block for analgesia after shoulder arthroscopy. METHODS: In the study, 40 patients of ASA I-II were selected for elective general anesthesia to repair the shoulder ligament rupture in Peking University Third Hospital, who were randomly divided into two groups, respectively for the intermuscular brachial plexus block group (group I) and C5-6 nerve root block group (group C), n=20. The forty patients underwent ultrasound-guided brachial plexus block or C5-6 nerve root block before general anesthesia. Group I: 0.2% ropivacaine 10 mL was injected into brachial plexus intermuscular approach; Group C: 0.2% ropivacaine 10 mL was injected around the nerve roots of C5 and C6, and the ultrasound images showed that the liquid wrapped nerve roots. The time of sensory and motor block after puncture, operation time, the time of postoperative analgesia, numerical rating scale (NRS) scores at 1, 6, 12, and 24 h postoperatively and the finger movements were recorded. The adverse drug reactions and the patient satisfaction were recorded. The primary end point was the study of shoulder rest and movement pain in the patients with postoperative nerve blockage; the secondary end point was the patient's limb movements and thepatient satisfaction. RESULTS: The duration of analgesia was (571.50±70.11) min in group I and (615.60±112.15) min in group C, and there was no difference between the two groups (P>0.05). The static and dynamic NRS scores at 1, 6, and 12 h in group C were lower than those in group I (P<0.05). There was no difference in static and dynamic NRS scores between the two groups during 24 hours (P>0.05). There was a significant difference in grade of muscle strength between group C [5(4,5)] and group I [4(2,4)] in the patients with nerve block hind limb (P<0.01), and there were significant differences between the two groups' sensation in the radial nerve group C [1(0,2)] and group I [2(1,2)], the median nerve group C [0(0,2)] and group I [2(1,2)], and the ulnar nerves group C [0(0,1)] and group I [1(1,2)] (P<0.01). There was no statistical difference between the two groups in the sencation of the shoulder, group C 2(1,2) and group I 2(1,2) , P>0.05. Compared with group I 8(6,9), group C 9(8,10) was a significant difference in satisfaction (P<0.01). CONCLUSION Interscalene brachial plexus block and C5-6 nerve root block could satisfy the needs of analgesia after shoulder arthroscopy, but C5-6 nerve root blockage does not limit the limb activity, the numbness is less, and the patient's satisfaction is higher.
Amides ; Analgesia ; Anesthetics, Local ; Arthroscopy ; Brachial Plexus ; Brachial Plexus Block ; Humans ; Nerve Block ; Pain, Postoperative ; Shoulder