Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2007
Modified lateral block of the suprascapular nerve: a safe approach and how much to inject? A morphological study.
This paper presents an evaluation of a modified lateral suprascapular nerve block with easy orientation, low risk of displacement of the needle, and with an assessment of 2 different volumes to propose an ideal volume for a successful block. ⋯ Based on this cadaver study, the lateral modified approach appears to be a safe technique for a suprascapular nerve block, which might be preferred as a single shot technique. A 5 mL volume appears sufficient to fill the supraspinous fossa and to reach the suprascapular nerve, which branches in this anatomical compartment.
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Reg Anesth Pain Med · Nov 2007
Randomized Controlled Trial Comparative StudyPostoperative epidural analgesia after total knee arthroplasty with sufentanil 1 microg/ml combined with ropivacaine 0.2%, ropivacaine 0.125%, or levobupivacaine 0.125%: a randomized, double-blind comparison.
Total knee replacement is associated with severe postoperative pain that, if treated insufficiently, interferes with early rehabilitation. The purpose of the present study is to compare the efficacy of ropivacaine (0.2% and 0.125%) and levobupivacaine (0.125%), all in combination with sufentanil 1 microg/mL with regard to postoperative pain relief and absence of motor block in a patient-controlled epidural analgesia setting. ⋯ All 3 solutions provided adequate analgesia and minimal motor block. The higher concentration of ropivacaine 0.2% was associated with a higher consumption of local anesthetic and did not result in a decrease in the consumption of sufentanil. Under the conditions of this study, patient-controlled epidural analgesia consumption of the epidural mixture was predominantly determined by sufentanil.
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Reg Anesth Pain Med · Nov 2007
Posterior lumbar plexus block in children: a new anatomical landmark.
Posterior lumbar plexus block is a well established anesthetic technique for lower limb surgeries. Both magnetic resonance imaging and clinical prospective studies were performed to verify if a new palpable landmark could be used for lumbar plexus block in pediatric patients. ⋯ The sulcus formed by the division between the longissimus and the iliocostal muscles is a simple, direct, and easy-to-identify landmark for posterior lumbar plexus block in children.
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In neuraxial anesthesia, increase of skin temperature is an early sign of successful block. Yet, during peripheral nerve block of the lower extremity, increase in skin temperature is a highly sensitive, but late sign of a successful block. We hypothesized that after interscalene brachial plexus block, a rise in skin temperature follows impairment of sensation during successful nerve block and occurs only distally, as observed in the lower extremity. ⋯ Assessment of skin temperature cannot predict the success of an interscalene brachial plexus block of the axillary and musculocutaneous nerve. Distally, the increase of skin temperature has a high sensitivity and specificity but occurs later than the loss of sensory and motor functions. Therefore, the measurement of skin temperature during interscalene blockade is of limited clinical value.
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Reg Anesth Pain Med · Nov 2007
Case ReportsThree-dimensional, multiplanar, ultrasound-guided, radial nerve block.
We describe the use of 3-dimensional, multiplanar ultrasound imaging for peripheral nerve block. ⋯ Three-dimensional, multiplanar ultrasound in real-time has the potential to improve nerve identification and accuracy of needle placement in regional anesthesia.