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Purpose: To investigate the anesthetic efficacy of various concentrations of ropivacaine in ultrasound-guided brachial plexus block surgery in the inter-costoclavicular space. Methods: 94 patients for brachial plexus block surgery identified from March 2021 to March 2023 in Jilin Province, China were selected as the study subjects; they were divided into control group and study group, and the control group received 0.3% ropivacaine 20 ml while the study group received 20 ml of 0.4% ropivacaine. The nerve block efficiency, secondary evaluation index, VAS scores at 12 h, 24 h and 48 h after surgery and the occurrence of adverse reactions were determined. Results: There was no notable difference in the success rate of nerve block between the control and study group (91.49 % vs 95.74 %, χ² = 0.712, p = 0.399). In comparison to control, the study group exhibited no noteworthy variance in the commencement time of the sensory block, whereas the remaining three indicators were significantly shortened (p < 0.05). The VAS scores at 12 and 24 h after surgery were markedly lower compared to the control (p < 0.05), while at 48 h, VAS scores were slightly lower (p > 0.05). There was no significant disparity in the overall incidence of adverse reactions between the two groups (4.26 vs. 6.38 %), neither were there serious complications such as tube nerve injury, local anesthetic poisoning, Horner's syndrome, pneumothorax, and postoperative sensory-motor abnormalities (p < 0.05). Conclusion: Using 0.4 % ropivacaine in ultrasound-guided intercostal brachial plexus block surgery achieves a higher success rate, enhances nerve block onset and duration, and improves postoperative pain relief, all without raising the incidence of adverse reactions, when compared to the use of 0.3 % ropivacaine concentration. However, larger clinical trials are required before the application of this strategy in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Regional anesthesia with ultrasound-guided brachial plexus block is widely used for patients undergoing shoulder and upper limb surgery, but needle misplacement can result in complications. The purpose of this study was to develop and validate a convolutional neural network (CNN) model for segmentation of the brachial plexus at the interscalene level. Methods: This prospective study included patients who underwent ultrasound-guided brachial plexus block in the Anesthesiology Department of Beijing Jishuitan Hospital between October 2019 and June 2022. A Unet semantic segmentation model was developed to train the CNN to identify the brachial plexus features in the ultrasound images. The degree of overlap between the predicted segmentation and ground truth segmentation (manually drawn by experienced clinicians) was evaluated by calculation of the Dice index and Jaccard index. Results: The final analysis included 502 images from 127 patients aged 41 ± 14 years-old (72 men, 56.7%). The mean Dice index was 0.748 ± 0.190, which was extremely close to the threshold level of 0.75 for good overlap between the predicted and ground truth segregations. The Jaccard index was 0.630 ± 0.213, which exceeded the threshold value of 0.5 for a good overlap. Conclusion: The CNN performed well at segregating the brachial plexus at the interscalene level. Further development could allow the CNN to be used to facilitate real-time identification of the brachial plexus during interscalene block administration. Clinical trial registration: The trial was registered prior to patient enrollment at the Chinese Clinical Trial Registry (ChiCTR2200055591), the site url is https://www.chictr.org.cn/. The date of trial registration and patient enrollment is 14/01/2022. [ABSTRACT FROM AUTHOR]

Purpose: The totally implantable venous access port (TIVAP) provides patients with safe, effective and long-term convenient venous access for the administration of medications such as chemotherapy drugs. The implantation and long-term use of TIVAP are related to thrombosis, infection and other complications. In this study, the medical records of multicentre patients were collected, and the perioperative and postoperative complications were retrospectively analysed to objectively evaluate the safety of the implantation of supraclavicular, ultrasound-guided TIVAP via the brachiocephalic vein (BCV).Patients and Methods: We retrospectively analysed the clinical data of 433 adult patients who had undergone ultrasound-guided TIVAP implantation via the BCV at four hospitals in China from March 2018 to May 2019. The success rates of the first puncture, operation time, and perioperative and postoperative complications were analysed.Results: All the TIVAPs were implanted successfully (100%). The average TIVAP carrying time was 318.15 ±44.22 days (range: 38-502 days) for a total of 197,694 catheter days. The success rate of the first puncture was 94.92% (411/433), and the average operation time was 29.66 ±7.45 min (range: 18-60 min). The perioperative complications included arterial puncture in 4 patients and pneumothorax in 1 patient. The incidence of postoperative complications was 5.08% (22/433), including poor incision healing (n = 2), catheter-related infection (n = 3), port infection (n = 6), thrombosis (n = 2) and fibrin sheath formation (n = 8). Another patient had infusion disturbance 2 days after the operation, and chest X-ray showed bending at the connection between the catheter and port. No other serious complications occurred, such as catheter rupture and drug leakage. The total incidence of complications was 6.24% (27/433).Conclusion: This study showed excellent tolerance of supraclavicular, ultrasound-guided BCV puncture to implant TIVAP and a low incidence of complications. As a safe and effective method of TIVAP implantation, it can provide a new choice for clinicians. [ABSTRACT FROM AUTHOR]

This number of attendees for a virtual hand surgery conference exceeds by half the largest hand surgery face-to-face congresses globally. In fact, I was unaware that this hand surgery conference could have a total of over 7000 attendees with so many posts and doubted this number this initially. Hand surgeons in China do not often wait for 15-30 min to start surgery after injection of local anaesthesia with epinephrine. [Extracted from the article]

Ultrasound-guided costoclavicular block (CC-approach) is a recently described brachial plexus block (BPB) and an alternative approach to the supraclavicular approach (SC-approach). The relevant sonoanatomy is analogous in terms of the brachial plexus and its adjacent artery for both approaches. In the present study, we hypothesized that the two approaches will result in similar block dynamics when used the modified double-injection (MDI) technique. One hundred and twelve patients were randomly allocated to receive either a SC- or CC-approach with MDI technique. In the CC group, half the volume was injected adjacent to the medial cord of the brachial plexus, the procedure was guided by ultrasound and verified by nerve stimulator, subsequently the second half was injected close to the lateral cord. In the SC group, the MDI technique was carried out as described in our previous study. Sensory and motor blockade of all four terminal nerves were assessed with a 3-point scale. The primary outcome was the proportion of complete sensory blockade at 15 min with a predefined non-inferiority margin of -13%. The proportion of subjects at 15 min was comparable between the SC group and the CC group (91 vs 87%, absolute difference: -3%). No significant differences were found for complete motor blockade and onset times of the individual nerves within 30 min, and block-related serious adverse events (all P>0.05). We conclude that the MDI technique applied to a costoclavicular and supraclavicular block resulted in similar block dynamics. In addition, it may provide a promising alternative technique when considering the use of multipoint injection., (© 2020 The Author(s).)