Total Intravenous Anaesthesia with Propofol and Dexmedetomidine for Brachial Plexus Repair with Intraoperative Neuromuscular Monitoring: A Case Series
TIVA for PNS Guided Brachial Plexus Repair: Case Series
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Abstract
Background: Brachial plexus surgery requires neural repair with the use of intraoperative peripheral nerve stimulation without muscle relaxants.
Methods: Twelve cases were conducted under total intravenous anaesthesia, receiving intravenous propofol, fentanyl and dexmedetomidine infusion. Intraoperative hemodynamic conditions and postoperative functional recovery were assessed.
Results: 9 out of 12 cases were stable while one was in a lighter plane requiring 20 mg propofol and increased dexmedetomidine, two had bradycardia requiring reduced dexmedetomidine infusion. At three months, five cases showed improvement.
Conclusion: Satisfactory conditions were achieved including hemodynamic stability, and muscle-sparing improving prognoses of brachial plexus surgeries.
[1] Bertelli JA, Ghizoni MF. Results and current approach for Brachial Plexus reconstruction. Journal of brachial plexus and peripheral nerve injury. 2011; 6(1):2.
[2] Noble J, Munro CA, Prasad VS, Midha R. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma. 1998;45(1):116-122.
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[5] Thatte MR, Babhulkar S, Hiremath A. Brachial plexus injury in adults: Diagnosis and surgical treatment strategies. Ann Indian Acad Neurol. 2013; 16(1):26-33.
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[7] Campbell WW. Evaluation and management of peripheral nerve injury. Clin Neurophysiol. 2008;119(9):1951–65.
[8] Saba R, Brovman EY, Kang D, Greenberg P, Kaye AD, Urman RD. A Contemporary Medicolegal Analysis of Injury Related to Peripheral Nerve Blocks. Pain Physician. 2019; 22(4):389–400.
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[10] David M. Polaner, Santhanam Suresh, Charles J. Coté, [book auth.] W.B. Saunders. Regional Anesthesia. In: Lerman Jerrold, Todres I David, Coté Charles J, editors. A Practice of Anesthesia for Infants and Children. 4th ed. Elsevier Publication; 2009. p. 867–910.
[11] Kaur M, Singh P. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res. 2011; 5(2):128–33.
[12] Mousa SA, Abd Elfatah Alsobky H. Efficacy and effect of TIVA with propofol or dexmedetomidine versus sevoflurane without muscle relaxant during repair of the brachial plexus. Egyptian J Anaesthesia. 2013; 29(1):31–40.
[13] Park J-W, Kim E-K, Lee H-T, Park S, Do S-H. The Effects of Propofol or Dexmedetomidine Sedation on Postoperative Recovery in Elderly Patients Receiving Lower Limb Surgery under Spinal Anesthesia: A Retrospective Propensity Score-Matched Analysis. J Clin Med. 2021; 10(1):135.
[14] Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clin Pharmacokinet. 2017; 56(8):893–913.
[15] Szymanski MW, Singh DP. Isoproterenol. [Updated 2021 Nov 8]. In: Treasure Island (FL), editor. In: StatPearls [Internet]. StatPearls Publishing; 2022.
[16] Mah GT, Turgeon RD, Loh G, Tejani AM, Sweet DD. Ketamine and propofol in combination for adult procedural sedation and analgesia in the emergency department. Cochrane Database Syst Rev. 2015.
[17] Akheela MK, Chandra A. Comparative Evaluation of Nalbuphine and Fentanyl for Attenuation of Pressor Response to Laryngoscopy and Tracheal Intubation in Laparoscopic Cholecystectomy. Cureus. 2021.
[18] Sahni N, Anand LK, Gombar K, Gombar S. Effect of intraoperative depth of anesthesia on postoperative pain and analgesic requirement: A randomized prospective observer blinded study. J Anaesthesiol Clin Pharmacol. 2011; 27(4):500–5.
[2] Noble J, Munro CA, Prasad VS, Midha R. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma. 1998;45(1):116-122.
[3] Kim DH, Murovic JA, Tiel RL, Kline DG. Mechanisms of injury in operative brachial plexus lesions. Neurosurg Focus. 2004 May 15;16(5):2.
[4] Armas-Salazar A, García-Jerónimo AI, Villegas-López FA, Navarro-Olvera JL, Carrillo-Ruiz JD. Clinical outcomes report in different brachial plexus injury surgeries: a systematic review. Neurosurg Rev. 2022; 45(1):411-419.
[5] Thatte MR, Babhulkar S, Hiremath A. Brachial plexus injury in adults: Diagnosis and surgical treatment strategies. Ann Indian Acad Neurol. 2013; 16(1):26-33.
[6] Bhandari PS, Maurya S. Recent advances in the management of brachial plexus injuries. Indian J Plast Surg. 2014; 47(2):191-8.
[7] Campbell WW. Evaluation and management of peripheral nerve injury. Clin Neurophysiol. 2008;119(9):1951–65.
[8] Saba R, Brovman EY, Kang D, Greenberg P, Kaye AD, Urman RD. A Contemporary Medicolegal Analysis of Injury Related to Peripheral Nerve Blocks. Pain Physician. 2019; 22(4):389–400.
[9] Menorca RM, Fussell TS, Elfar JC. Nerve physiology: mechanisms of injury and recovery. Hand Clin. 2013; 29(3):317–30.
[10] David M. Polaner, Santhanam Suresh, Charles J. Coté, [book auth.] W.B. Saunders. Regional Anesthesia. In: Lerman Jerrold, Todres I David, Coté Charles J, editors. A Practice of Anesthesia for Infants and Children. 4th ed. Elsevier Publication; 2009. p. 867–910.
[11] Kaur M, Singh P. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res. 2011; 5(2):128–33.
[12] Mousa SA, Abd Elfatah Alsobky H. Efficacy and effect of TIVA with propofol or dexmedetomidine versus sevoflurane without muscle relaxant during repair of the brachial plexus. Egyptian J Anaesthesia. 2013; 29(1):31–40.
[13] Park J-W, Kim E-K, Lee H-T, Park S, Do S-H. The Effects of Propofol or Dexmedetomidine Sedation on Postoperative Recovery in Elderly Patients Receiving Lower Limb Surgery under Spinal Anesthesia: A Retrospective Propensity Score-Matched Analysis. J Clin Med. 2021; 10(1):135.
[14] Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clin Pharmacokinet. 2017; 56(8):893–913.
[15] Szymanski MW, Singh DP. Isoproterenol. [Updated 2021 Nov 8]. In: Treasure Island (FL), editor. In: StatPearls [Internet]. StatPearls Publishing; 2022.
[16] Mah GT, Turgeon RD, Loh G, Tejani AM, Sweet DD. Ketamine and propofol in combination for adult procedural sedation and analgesia in the emergency department. Cochrane Database Syst Rev. 2015.
[17] Akheela MK, Chandra A. Comparative Evaluation of Nalbuphine and Fentanyl for Attenuation of Pressor Response to Laryngoscopy and Tracheal Intubation in Laparoscopic Cholecystectomy. Cureus. 2021.
[18] Sahni N, Anand LK, Gombar K, Gombar S. Effect of intraoperative depth of anesthesia on postoperative pain and analgesic requirement: A randomized prospective observer blinded study. J Anaesthesiol Clin Pharmacol. 2011; 27(4):500–5.
| Files | ||
| Issue | Vol 9 No 2 (2023): Spring |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v9i2.12505 | |
| Keywords | ||
| Total intravenous anesthesia Brachial plexus Neuromuscular Monitoring Propofol Dexmedetomodine | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Chaudhuri A, Kuttarmare S, Bhalerao P, Kamble N. Total Intravenous Anaesthesia with Propofol and Dexmedetomidine for Brachial Plexus Repair with Intraoperative Neuromuscular Monitoring: A Case Series. Arch Anesth & Crit Care. 2023;9(2):102-106.
