Regional anesthesia and pain medicine
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Ultrasound is a novel method of nerve localization but its use for lower extremity blocks appears limited with only reports for femoral 3-in-1 blocks. We report a case series of popliteal sciatic nerve blocks using ultrasound guidance to illustrate the clinical usefulness of this technology. ⋯ Our preliminary experience suggests that ultrasound localization of the sciatic nerve in the popliteal fossa is a simple and reliable procedure. It helps guide block needle placement and assess local anesthetic spread pattern at the time of injection.
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Reg Anesth Pain Med · Mar 2004
Editorial Comment Historical ArticleBirth of an idea: the epidural blood patch.
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Reg Anesth Pain Med · Mar 2004
Case ReportsConversion disorder mimicking Dejerine-Roussy syndrome (thalamic stroke) after spinal cord stimulation.
Dejerine-Roussy syndrome is a complex of various signs and symptoms in patients suffering from central thalamic pain, usually secondary to a vascular etiology. We describe a patient presenting with the potentially devastating signs and symptoms of thalamic stroke, at least temporally related to spinal cord stimulator implantation. The etiology of the patient's affliction was subsequently revealed to be a conversion disorder. Case report A 37-year-old woman presented for spinal cord stimulation as treatment of her brachial plexopathy after failure of conservative therapy. Before implantation, she underwent a clinical interview with a psychologist and psychometric testing. No psychological pathology was detected. Trial and permanent implantation of the cervical stimulator lead and pulse generator were uneventful. Eleven days after receiving the permanent implant, the patient experienced right-sided hemicorporal numbness and burning dysesthesia. The patient was admitted, and a diagnosis of Dejerine-Roussy syndrome (thalamic stroke) was made. She was discharged, and her symptomatology waxed and waned over a period of weeks. The patient was subsequently admitted for psychiatric evaluation because of anxiety attacks. During her protracted admission, her psychiatrists strongly suspected a conversion disorder. The stimulator was removed, and the patient received supportive care only. Within 6 months, sensory symptoms and all motor deficits had completely resolved. ⋯ Despite careful preoperative evaluation, latent psychosocial issues may limit the effectiveness of spinal cord stimulation. We present a case of conversion disorder masquerading as Dejerine-Roussy syndrome after spinal cord stimulation. The implications of the failure of preoperative psychological evaluation and screening to avert implantation are discussed.
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Reg Anesth Pain Med · Mar 2004
Diaphragmatic excursion and respiratory function after the modified Raj technique of the infraclavicular plexus block.
The effects of the infraclavicular plexus block using the modified Raj approach on diaphragm and respiratory function have not been investigated. ⋯ Infraclavicular block using the modified Raj technique did not interfere with diaphragmatic excursion or respiratory function.
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The public is not well informed about matters relating to regional anesthesia. Previous studies concerning regional anesthesia have involved patients, surgeons, and anesthesiologists. This study is the first in-depth survey of the attitudes of the general public toward a number of commonly perceived fears about regional anesthesia. ⋯ The public's fears and conceptions about regional anesthesia are greatly distorted. The anesthesia community has not been successful in keeping the public informed about regional anesthesia. Future anesthesia-related educational programs should address the concerns of the public about anesthesia matters, particularly regional anesthesia.