Regional anesthesia and pain medicine
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This cadaveric study investigated the innervations of the clavicle and clavicular joints (ie, sternoclavicular and acromioclavicular joints). ⋯ The clavicle and clavicular joints are innervated by the subclavian, lateral pectoral, and supraclavicular nerves. Clinical trials are required to determine the relative importance and functional contribution of each nerve.
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Reg Anesth Pain Med · Dec 2021
Trajectories of opioid consumption from day of surgery to 28 days postoperatively: a prospective cohort study in patients undergoing abdominal, joint, or spine surgery.
Descriptions of opioid use trajectories and their association with postsurgical pain and opioid consumption are limited. We hypothesized that trajectories of opioid consumption in the first 28 days following surgery would be associated with unique patterns of pain and duration of opioid use. ⋯ We observed distinct opioid use trajectories following abdominal and joint or spine surgery that were associated with different patterns of pain and duration of opioid use postoperatively. Prediction of postoperative opioid use trajectory groups may be clinically important for identifying risk of prolonged opioid use.
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Reg Anesth Pain Med · Dec 2021
Severe altered mentation due to cervicothoracic intrathecal pump after correction of cervical stenosis: a case report.
Cerebral spinal fluid (CSF) dynamics are complex and changes in spinal anatomy may influence the rostrocaudal movement of intrathecal medications. We present the first reported case demonstrating that acute cervical spinal stenosis may impede the distribution of adjacent intrathecal medications, and that correction of such stenosis and the resulting changes in CSF flow may necessitate significant adjustments in the intrathecal infusates. ⋯ This case presents clinical evidence that severe spinal stenosis may impede the rostral CSF distribution of intrathecal medications. Intrathecal medications previously tolerated by patients prior to decompression may need to be significantly reduced in the postoperative period.
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Reg Anesth Pain Med · Dec 2021
American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part I: clinical indications.
Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine (ASRA) commissioned this narrative review to provide recommendations for POCUS. ⋯ The clinical review addresses airway ultrasound, lung ultrasound, gastric ultrasound, the focus assessment with sonography for trauma examination and focused cardiac ultrasound for the regional anesthesiologist and pain physician. It also provides foundational knowledge regarding ultrasound physics, discusses the impact of handheld devices and finally, offers insight into the role of POCUS in the pediatric population.
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Reg Anesth Pain Med · Dec 2021
Randomized trial comparing the spread of erector spinae block with the combination of erector spinae block and retrolaminar block in soft embalmed Thiel cadavers.
Erector spinae plane (ESP) and retrolaminar (RL) blocks show unreliable spread. We hypothesize that the combination of ESP and RL blocks provides more extensive and reliable spread of dye than single ESP blocks. Our primary objective was to compare the spread of dye to the paravertebral spaces after the combination block and ESP block in Thiel embalmed cadavers. Spread, the primary end point, was defined as the number of paravertebral spaces colored with dye per injection. ⋯ In conclusion, the combination of ESP and RL blocks was more extensive and reliable than ESP block alone.