Online ISSN: 2515-8260

Keywords : Brachial Plexus


ROLE OF 3T MAGNETIC RESONANCE IMAGING IN EVALUATION OF BRACHIAL PLEXUS.

Dr. Aastha Agarwal, Dr. Varsha Rangankar, Dr. Reetika Kapoor

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 3214-3229

The aim of the present study was to assess the role of 3T Magnetic Resonance Imaging in evaluation of brachial plexus.
Methods: The Descriptive, cross-sectional study was conducted at Dr. D. Y. Patil Medical College and Hospital and Research Centre, Pimpri, Pune.  Sixty-eight patients who had undergone brachial plexus MRI from August 2020 to September 2022 duration were included in the study.
Results: Out of 68 patients, the most common age group was 20-40 (55.9%) and majority were male patients (73.5%). Out of 68 patients, brachial plexus was found to be abnormal on MRI in 40 patients (58.8%) with unilateral involvement in 36 patients (90%) and bilateral involvement in 4 patients (10%). The most common pathology was brachial plexus injury, found in 25 cases (36.7%), followed by root compression in 9 cases (13.2%), parsonage turner syndrome in 5 cases (13.2%), primary brachial plexus tumors in 5 cases (7.3%) and secondary involvement of brachial plexus by metastases in 2 cases (2.9%). Fibrosis was seen in 3 cases (4.4%). On level wise analysis of brachial plexus involvement, the trunks were involved in 26 patients (38.2%), divisions were involved in 21 patients (30.9%), cords were involved in 22 patients (32.4%) and terminal branches were involved in 19 patients (27.9%). Pre-ganglionic root injury was found in 3 cases (4.4%), while 8 cases each of post-ganglionic root injury (11.7%) and pre plus post-ganglionic root injury (11.7%) were seen. On MRI and NVC/EMG correlation, MRI was found to be 94.7% sensitive and 90% specific for brachial plexopathies.
Conclusion: 3T MRI of brachial plexus provides valuable information regarding the morphology, location and extent of both traumatic and non-traumatic brachial plexopathies

Observational Study Of Lidocaine Induced Systemic Toxicity When Used By Various Methods Of Administration

Dr. Shakeer Sayeed, Dr. Syed Nazima, Dr. Farhana Bashir, Dr. Saba Ahad, Dr. Yasir Wani, Dr. Farzana Bashir

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 3939-3948

Systemic local anesthetic toxicity is rare but can be fatal because of relative resistance of local anesthetic–induced cardiac arrest to standard resuscitative measures.
Aim: To observe Lidocaine induced systemic toxicity when it is used by its various methods of administration and review treatment and management strategies available for lidocaine toxicity.
Method: Prospective , observational study conducted on 120 patients, between the age group of 20-60 years ( of either sex ) of ASA grade 1-2, undergoing surgical procedures in which lidocaine (0.25-4%) was  administered by different modes at various  associated hospitals of GMC Srinagar.
Results:  In the present study, out of 120 patients, 7 patients developed systemic symptoms following lidocaine administration by different routes. Patients were categorised into three groups- epidural group, brachial plexus blockade group and local infiltration group (40 patients in each group). 4 patients developed symptoms following epidural administration and 3 patients following brachial plexus blockade and none with local infiltration. Systemic manifestations were more when lidocaine was used for epidural anesthesia followed by brachial plexus blockade and least with local infiltration. Conclusion: We concluded that the dose and route of administration of lidocaine are statistically significant factors in considering systemic manifestation. The treatment of systemic toxicity is primarily supportive with oxygenation, fluid administration and administration of benzodiazepines.CNS toxicity is either self limiting or quite amenable to treatment with benzodiazepines. Cardiac toxicity may require resuscitation with fluids but the prognosis after return to spontaneous circulation is often very good.
 

Evaluation of The Efficacy of Dexmedetomidine And Dexamethasone When Used As Adjuvant To Ropivacaine In Supraclavicular Brachial Plexus Block for Upper Limb Surgeries

Dr Abhilash Dash; Dr Rabi Narayan Dhar; Dr Ramakanta Mohanty; Dr Sidharth Sraban Routray; Dr Soumyakant Mallick

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 6, Pages 1166-1173

We have done this trialin order to correlate analgesic dexmedetomidine (DXM) &dexamethasone (DX) efficacyin form of an additive for supraclavicular brachial plexus(SCBP)‘s ropivacaine blockage for upper extremity surgery. This is trial in which, 18–65 yrs 70 ASA status type one and two individuals suffering from disease, posted for upper extremity surgery was splitrandomly within couple of categories. Class DXMgot 2 mlof normal saline containing dexmedetomidine (1mcg/kg) with 0.5%ropivacaine(30 ml) and Class DXgot 2 ml(8 mg) of dexamethasone with 0.5%ropivacaine(30 ml). SCBP block was performed under ultrasonography(USG). The primary outcome was time of 1st analgesic request and no of analgesic request in 1st 24hrs. Secondary endresult of the trial were Motor block& sensory were secondary trial end result onset & time & incidence associated with drug’sside effects. Time for request of 1st rescue analgesia was 720.50±67.87min in Class DXM and 591.83±52.25min in Class DX. Total rescue analgesia required within post -operative for 1 dayinto DXM Class is less in comparison to DX Class. The mean of onset time of motor block& sensory into Class DXM is lesser in comparison to Class DX, which is statistically important. In Class DXM mean of duration of sensory block was 656.50± 50.58min, which was significantly longer than Class DX where duration was 534.10± 62.43min. Mean of motor block duration was 611.83± 45.3min in Class DXM and 470.83± 59.40min in Class DX (p<0.001). Dexmedetomidine provided prolonged relief from suffering after utilizing it in form of an additive to SCBP portion’s ropivacaine when compared to dexamethasone