T10 and T11 vertebral will be located and marked as the same way as that mentioned above in ESPB group. The probe will then be moved 3–5 cm laterally to identify the paravertebral space as the target injection site. After probe being rotated into transverse orientation, a 22-gauge nerve block needle (80 mm, Stimuplex D, B. Braun, Germany) will be inserted using the in-plane technique. Once the needle threads the internal intercostal membrane and arrives in the paravertebral space, 3 ml of normal saline will be injected firstly. If displacement sign of the pleura occurs, the prepared study drug will be then injected into the confirmed paravertebral space. Successful study drug injection is defined as the appearance of pleura displacement sign and hypoechoic ellipsoid in paravertebral space under ultrasonic view.
Stimuplex d
Manufactured by B. Braun
Sourced in Germany
The Stimuplex D is a high-quality nerve stimulator designed for precise nerve location during regional anesthesia procedures. It provides a constant current output with adjustable intensity to elicit muscle contractions, enabling accurate identification of the target nerve.
Automatically generated - may contain errors
7 protocols using stimuplex d
1
Ultrasound-Guided Paravertebral Injection
2
Ultrasound-Guided Thoracic Paravertebral Block
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Ultrasound-guided TPVB was performed by one experienced anesthetist with a low frequency (2 ~ 5 MHz) curved array transducer (SonoSite M-Turbo; SonoSite Inc., Bothell, WA, USA). Patients were placed in the lateral position with the side to be operated upwards. Using aseptic precautions, the T4 and T5 paravertebral space was located by counting from the 12th rib to the 4th rib. TPVB was performed at the T4 paravertebral space first. The transducer was placed at an oblique transverse position along the long axis of the rib and tilted until the transverse process, the internal intercostal membrane and the pleura were visualized. After infiltration with 2 ml of 1% lidocaine, a 22-gauge, 120-mm stimuplex needle (Stimuplex® D; B. Braun; Melsungen; Germany) was advanced from lateral to medial with in-plane technique under real-time ultrasound guidance. Once the needle passed through the internal intercostal membrane, 10 ml of 0.4% ropivacaine was injected. Using the same technique, another 10 ml of 0.4% ropivacaine was injected at the T5 paravertebral space.
3
Ultrasound-Guided Peripheral Nerve Blocks
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For the procedure, patients were placed in a supine position on the operating table. Vital signs were monitored according to current standards of care,16 which included three-lead-electrocardiogram, automated non-invasive bp, and pulse oximetry monitoring. Oxygen was applied via a non-rebreathing mask and an i.v. line inserted. Analgesia and sedation were achieved by continuous infusion of remifentanil 0.05–0.1 mcg·kg−1·min−1 and a 0.01–0.05 mg·kg−1 bolus of midazolam.
The respective extremity was elevated such that the popliteal region was accessible for the ultrasound probe. The nerve blocks were performed using the standard lateral in-plane ultrasound-guided approach,17 (link) using a SonoSite S-Nerve ultrasound machine (SonoSite, WA, USA) with a 10–15MHz linear transducer, a 20G, 120mm ultrasound needle (Stimuplex-D, BBraun, Melsungen, Germany) and a Stimuplex HNS 12 nerve stimulator (BBraun, Melsungen, Germany).
The respective extremity was elevated such that the popliteal region was accessible for the ultrasound probe. The nerve blocks were performed using the standard lateral in-plane ultrasound-guided approach,17 (link) using a SonoSite S-Nerve ultrasound machine (SonoSite, WA, USA) with a 10–15MHz linear transducer, a 20G, 120mm ultrasound needle (Stimuplex-D, BBraun, Melsungen, Germany) and a Stimuplex HNS 12 nerve stimulator (BBraun, Melsungen, Germany).
4
Ultrasound-Guided Erector Spinae Plane Block
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Patients in ESPB group will be scanned by the linear high-frequency probe firstly placed in sagittal orientation at the middle scapula line. Once the imaging of the 12th rib emerges, T12 spinous process (SP) will be traced by sliding the probe medially and then marked. The probe will be then traced cranially to locate the T10-T11 vertebral. After the same marked method, the probe will be continually moved 3–5 cm laterally and rotated in transverse orientation to identify the muscle layers of erector spinae and transverse processes near the marked site.
After re-confirming the important anatomic structure including lumbar artery under ultrasound scan, a 22-gauge nerve block needle (80 mm, Stimuplex D, B. Braun, Germany) will be inserted in-plane through a medial-lateral direction. Once the needle tip arrives beneath the erector spinae muscle, 3 ml of normal saline will be injected firstly to ensure correct positioning of the needle after aspiration. The prepared study drug will be then injected into this plane with aspiration every 5 ml per injection in case of accidental puncture of vessel or pleura. Successful study drug injection is defined as the appearance of a hypoechoic ellipsoid with well-defined margin beneath erector spinae muscle on ultrasonic view.
After re-confirming the important anatomic structure including lumbar artery under ultrasound scan, a 22-gauge nerve block needle (80 mm, Stimuplex D, B. Braun, Germany) will be inserted in-plane through a medial-lateral direction. Once the needle tip arrives beneath the erector spinae muscle, 3 ml of normal saline will be injected firstly to ensure correct positioning of the needle after aspiration. The prepared study drug will be then injected into this plane with aspiration every 5 ml per injection in case of accidental puncture of vessel or pleura. Successful study drug injection is defined as the appearance of a hypoechoic ellipsoid with well-defined margin beneath erector spinae muscle on ultrasonic view.
5
Ultrasound-Guided Psoas-Ischiatic Nerve Blocks
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Psoas-ischiatic nerve blocks were performed combining ultrasound- and nerve stimulator-guided (Stimuplex HNS 12; B Braun) techniques. Ultrasound guidance was performed using a high-frequency 12 MHz linear array transducer (HS 50; Samsung or Mylab 30 gold; Esaote).
The dogs were positioned in lateral recumbency with the limb to be operated uppermost. The anatomical site was then aseptically prepared and the positive electrode for stimulation was applied to the skin of the ventral abdomen.
Ropivacaine (Naropina® 0.75%; Fresenius Kabi) was diluted with an equivalent volume of 0.9% saline solution (Sodium chloride 0.9%; Fresenius Kabi) to obtain a 0.375% ropivacaine solution. A syringe containing 0.45 mL/kg of 0.375% (equivalent to 1.69 mg/kg) ropivacaine was aseptically prepared and connected to an insulated stimulating needle of appropriate length (Stimuplex D; B Braun).
The dogs were positioned in lateral recumbency with the limb to be operated uppermost. The anatomical site was then aseptically prepared and the positive electrode for stimulation was applied to the skin of the ventral abdomen.
Ropivacaine (Naropina® 0.75%; Fresenius Kabi) was diluted with an equivalent volume of 0.9% saline solution (Sodium chloride 0.9%; Fresenius Kabi) to obtain a 0.375% ropivacaine solution. A syringe containing 0.45 mL/kg of 0.375% (equivalent to 1.69 mg/kg) ropivacaine was aseptically prepared and connected to an insulated stimulating needle of appropriate length (Stimuplex D; B Braun).
6
Ultrasound-Guided Thoracic Paravertebral Block
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Patients were placed in a standard lateral position to apply TPVB after induction of anesthesia. An anesthetic assistant neither involved in the study nor participating in the perioperative period or the postoperative follow-up prepared study drugs in a 20-mL syringe. Groups received isotonic saline (S), 0.5% ropivacaine (R), or 0.5% ropivacaine with 5 mg dexamethasone (RD) in the paravertebral space. TPVB was performed using an ultrasound-guided parasagittal outplane approach. The skin was prepared with chlorhexidine in isopropyl alcohol and then covered with a sterile sheet. A 22G, 120-mm needle (stimuplex D; B. Braun Melsungen AG, Melsungen, Germany) was guided using a real-time ultrasound machine (SonoSite M-Turbo, Bothell, WA, USA) with a C60x transducer (2–5 MHz) draped with a sterile cover (3M Tegaderm, St. Paul, MN, USA). Local anesthetic or saline was administered at the paravertebral spaces between T3–T4, T4–T5, and T5–T6 vertebrae with a bolus of 5–7 mL in each interspace region. Ultrasonography confirmed that the pleura shifted downward due to the local anesthesia.
7
Ultrasound-Guided Transversus Abdominis Plane Block
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All unilateral TAP blocks were performed by two experienced anaesthesiologists in the pre-anaesthesia unit before the induction of anaesthesia. Two per cent chlorhexidine solution was used to prepare the skin in both groups, and a high-frequency (10–18 MHz) ultrasound probe (Philips EPIQ 7C, Bothell, WA, USA) was used. We employed the lateral method to target the TAP compartment in the lateral abdominal wall between the midaxillary and anterior axillary lines.[4 (link)]
The probe was positioned transversely on the anterolateral abdominal wall between the midaxillary and anterior axillary lines close to the iliac crest until the external oblique muscle, internal oblique muscle [IOM] and TAM) were visible and the plane was identified between the IOM and TAM. Then, under sterile conditions, a 22G, 50-mm insulated Quincke-type needle (Stimuplex D; B Braun, 50 mm, Hessen, Germany) was inserted directly into the TAP. To check that the needle was in the proper location, a test injection with 12 ml physiological saline was done. Afterwards, 20 ml of 0.375% ropivacaine was administered to Group R and 20 ml of 0.375% ropivacaine +1 g/kg of dexmedetomidine to Group RD.
The probe was positioned transversely on the anterolateral abdominal wall between the midaxillary and anterior axillary lines close to the iliac crest until the external oblique muscle, internal oblique muscle [IOM] and TAM) were visible and the plane was identified between the IOM and TAM. Then, under sterile conditions, a 22G, 50-mm insulated Quincke-type needle (Stimuplex D; B Braun, 50 mm, Hessen, Germany) was inserted directly into the TAP. To check that the needle was in the proper location, a test injection with 12 ml physiological saline was done. Afterwards, 20 ml of 0.375% ropivacaine was administered to Group R and 20 ml of 0.375% ropivacaine +1 g/kg of dexmedetomidine to Group RD.
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