Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2015
Randomized Controlled Trial Comparative StudyHemidiaphragmatic Paralysis Following Ultrasound-Guided Supraclavicular Versus Infraclavicular Brachial Plexus Blockade: A Randomized Clinical Trial.
The comparative incidences of hemidiaphragmatic paralysis associated with contemporary ultrasound-guided supraclavicular versus infraclavicular blockade have not received extensive study. We tested the hypothesis that the infraclavicular approach results in a lower incidence of hemidiaphragmatic paralysis compared with supraclavicular blockade when a standard local anesthetic volume and concentration are used. ⋯ Ultrasound-guided supraclavicular blockade with 30 mL of 0.5% ropivacaine produced complete hemidiaphragmatic paralysis in approximately one-third of patients. The infraclavicular approach greatly reduced this risk but did not eliminate it. These data may aid in the selection of the approach to brachial plexus blockade, particularly in ambulatory patients and/or those with respiratory comorbidities.
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Reg Anesth Pain Med · Mar 2015
Fluoroscopic Evaluation of Contrast Distribution Within the Adductor Canal.
This case series assesses the in vivo spread of contrast within the adductor canal in subjects who recently underwent a total knee arthroplasty. A previous analysis of profound leg weakness with a continuous adductor canal revealed contrast spread from the adductor canal to the femoral triangle with as little as 2 mL of volume. ⋯ This study reveals that in vivo continuous infusions within the adductor canal spread in both a cephalad and caudad direction in limited fashion. Although a previous report described proximal spread of injectate to the level of the common femoral nerve, this event is infrequent.
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Reg Anesth Pain Med · Mar 2015
The interaction between the composition of preinjected fluids and duration of radiofrequency on lesion size.
Clinical recommendations for the duration of radiofrequency (RF) delivery have been based on no-fluid design, which may not be representative of clinical practice where fluid preinjection occurs. The purpose of this study was to examine the interaction between the preinjection of fluids of differing compositions and duration of RF on lesion size. The variability of lesion development under different preinjection conditions was also examined across the RF lesion duration. ⋯ Fluid preinjection alters both final lesion size and the time required to achieve maximum lesion size. Extending the duration of RF lesion cycle beyond 90 seconds when fluid is preinjected allows for lesion size to be maximized while limiting lesion size variability, both of which assist in successfully lesioning a targeted nerve.