Digital Public Defence: Anne Holmberg
Cand.med. Anne Holmberg at Institute of Clinical Medicine will be defending the thesis Plexus brachialis anaesthesia: Optimising clinical aspects for the degree of PhD (Philosophiae Doctor).
Photo: Amalie Huth Hovland, UiO
The public defence will be held as a video conference over Zoom.
The defence will follow regular procedure as far as possible, hence it will be open to the public and the audience can ask ex auditorio questions when invited to do so.
Due to copyright reasons, an electronic copy of the thesis must be ordered from the faculty. In order for the faculty to have time to process the order, it must be received by the faculty no later than 2 days prior to the public defence. Orders received later than 2 days before the defence will not be processed. Inquiries regarding the thesis after the public defence must be addressed to the candidate.
Digital Trial Lecture - time and place
- First opponent: Professor Lone Nikolajsen, Aarhus University, Denmark
- Second opponent: Professor Lars Marius Ytrebø, UiT - The Arctic University of Norway, Tromsø
- Third member and chair of the evaluation committee: Professor II Jan Erik Madsen, Institute of Clinical Medicine, University of Oslo
Chair of defence
Professor II Eirik Helseth, Institute of Clinical Medicine, University of Oslo
Professor II Johan Ræder, Institute of Clinical Medicine, University of Oslo
Infraclavicular nerve blocks are used for analgesia, anaesthesia and in special situations to improve peripheral circulation for the distal upper extremity. The aim of this thesis is to improve analgesic and circulatory benefits of the block by dedicated measures. We hypothesised that optimal use of infraclavicular blocks may improve clinical outcome by reduce acute and long-lasting postoperative pain and improve peripheral circulation.
We included patients with distal radius fractures scheduled for volar plate surgery in infraclavicular nerve block anaesthesia in two clinical studies on postoperative pain. In a third cross-over study in healthy volunteers, we evaluated the effect of infraclavicular blocks on peripheral microcirculation using laser Doppler fluxmetry, capillary video microscopy and temperature measurements.
We found a small, but significant improvement in early postoperative pain and lower analgesic consumption up to one week after surgery with pre-operative (i.e. pre-emptive) compared with postoperative blocks in the first study. Adding double anti-inflammatory prophylaxis (etoricoxib and intravenous dexamethasone) in the second study increased block duration and improved early postoperative analgesia, and may also reduce chronic pain. In the third study, subpapillary skin blood flow increased after infraclavicular blocks. Nutritive blood flow to the non-glabrous skin decreased when adrenaline was used as adjuvant, whereas no significant change occurred without adrenaline.
In conclusion, brachial plexus block should be performed pre-incisional rather than postoperatively and be combined with NSAIDs and intravenous dexamethasone to obtain optimal efficacy for management of acute and possibly also long-lasting pain after volar plate surgery. When used to increase the microcirculation and oxygenation of peripheral cells, the best approach may be to use a block without adrenaline added.
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