British journal of anaesthesia
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Dislocation rates of continuous peripheral nerve block are poorly described even though this technique is frequently used in clinical practice. The present study was designed to evaluate dislocation rates over time of interscalene and femoral nerve catheters under defined experimental circumstances. Ultrasound (US) monitoring was used to detect the position of the perineural catheters. ⋯ This is the first dedicated evaluation of dislocation rates of peripheral nerve catheters (PNCs) via US investigation. Both movement and time are considerable factors for perineural catheter displacement. US is useful for the performance of PNCs and for the continuous detection of the spread of fluid relative to the nerve and adjacent anatomical structures. Translational research is required to confirm the study results in the clinical practice.
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We report on a case in which computed tomography was used to guide placement of an epidural catheter in a patient with severe scoliosis and congenital dwarfism. In addition, the computed tomograms were corroborated with ultrasound and fluoroscopic images in the patient. Three years later, the patient had a spinal anaesthetic performed with only the use of ultrasound-guidance. ⋯ Moderate idiopathic scoliosis is managed with a paramedian approach on the convex-side of the curve or a midline approach with angulation towards the convex-side or with the aid of imaging such as ultrasound. Severe idiopathic scoliosis is managed with the assistance of imaging or an alternative form of pain management should be considered. A systematic approach may facilitate safe, efficient, and successful neuraxial anaesthesia procedures in the scoliotic patient.
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Letter Case Reports
Paediatric application of the EZ-Blocker for thoracoscopic sympathectomy.