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Related Concept Videos

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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
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Assessing a patient's pulse is a fundamental skill in healthcare, but certain situations require special attention:
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Pulse Assessment Sites01:11

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When the heart pumps blood out, arterial elastic fibers play a crucial role in sustaining a high-pressure gradient. They expand to accommodate the received blood and then recoil - a process known as the pulse that can be either manually palpated or electronically quantified. Despite a reduction in its effect with increased distance from the heart, elements of the pulse's systolic and diastolic components persist, observable even at the arteriole level.
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Palpation involves feeling the body to evaluate texture, size, consistency, and tenderness for assessing cardiovascular health. The following steps are organized in a head-to-toe order:
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Related Experiment Video

Updated: May 23, 2025

Laboratory Administration of Transcutaneous Auricular Vagus Nerve Stimulation taVNS: Technique, Targeting, and Considerations
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Changes in pulse wave transit time variability after interscalene brachial plexus block placement.

Eun Joo Choi1, Jung A Lim2, Chang Hyuk Choi3

  • 1Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea.

Korean Journal of Anesthesiology
|May 21, 2025
PubMed
Summary

Interscalene brachial plexus block (ISBPB) significantly increases pulse wave transit time (PWTT) and reduces its low-frequency power (LF). These changes suggest ISBPB-induced sympathectomy impacts cardiovascular autonomic regulation.

Keywords:
Autonomic nervous systemBrachial plexus blockFourier analysisPulse wave analysisRegional anesthesiaSympathectomy

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Area of Science:

  • Anesthesiology
  • Cardiovascular Physiology
  • Autonomic Nervous System Research

Background:

  • Pulse wave transit time (PWTT) reflects vascular tone and is influenced by autonomic nervous system activity.
  • Regional anesthesia, such as interscalene brachial plexus block (ISBPB), can cause sympathetic blockade, potentially altering cardiovascular parameters.
  • PWTT variability, particularly low-frequency power (LF), is linked to autonomic nervous system function.

Purpose of the Study:

  • To investigate the effect of interscalene brachial plexus block (ISBPB) on pulse wave transit time (PWTT).
  • To determine if ISBPB alters the low-frequency power (LF) of PWTT variability.
  • To explore the relationship between ISBPB and autonomic nervous system regulation via cardiovascular parameters.

Main Methods:

  • Fifty-six patients undergoing ISBPB were analyzed.
  • PWTT was measured as the interval between ECG R-peak and the second-derivative photoplethysmography peak.
  • Low-frequency power (LF) of PWTT variability was calculated using fast Fourier transform analysis.

Main Results:

  • PWTT significantly increased post-ISBPB compared to baseline (P < 0.001).
  • The natural log-transformed LF (lnLF) of PWTT variability significantly decreased post-ISBPB (P < 0.01).
  • Both PWTT and lnLF changes were observed between 5-10 and 15-20 minutes after block needle insertion.

Conclusions:

  • ISBPB administration leads to a significant increase in PWTT.
  • A significant reduction in the low-frequency power of PWTT variability was observed following ISBPB.
  • These findings suggest that ISBPB-induced sympathectomy influences cardiovascular autonomic regulation.