Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2007
Case Reports Clinical TrialFalls associated with lower-extremity-nerve blocks: a pilot investigation of mechanisms.
Documented falls after lower-extremity-nerve blocks are rare. We believe this paucity of documented falls is the result of underreporting and the lack of serious complications resulting from these falls. In addition, the mechanism(s) for falls after lower-extremity-nerve blocks has not been elucidated. ⋯ Lower-extremity-nerve blocks result in decreased leg stiffness and lateral instability, which may lead to difficulty with pivoting maneuvers.
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Reg Anesth Pain Med · Jan 2007
An alternate method of radiofrequency neurotomy of the sacroiliac joint: a pilot study of the effect on pain, function, and satisfaction.
The sacroiliac joint (SIJ) can be a source of chronic refractory mechanical spine pain. Few previous studies have described radiofrequency (RF) sensory denervation of the SIJ; results have been inconsistent and technically demanding. This uncontrolled, prospective, cohort study evaluates the effects of an innovative method of RF ablation of the posterior sensory nerves of the SIJ on pain, analgesic use, disability, and satisfaction of patients suffering with chronic mechanical SIJ pain. ⋯ RF sensory ablation of the SIJ using bipolar strip lesions is a technically uncomplicated and low-risk procedure. The resulting effects on pain, disability, and satisfaction are promising. Further evaluation of this technique, including randomized controlled trials, is recommended.
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Reg Anesth Pain Med · Jan 2007
Disclosure of risks associated with regional anesthesia: a survey of academic regional anesthesiologists.
In view of the relatively few large studies available to estimate the rates of complications following regional anesthesia, we aimed to identify and quantify the risks that academic regional anesthesiologists and regional anesthesia fellows disclose to their patients before performing central and peripheral nerve blockade. ⋯ The risks of regional anesthesia most commonly disclosed to patients by academic regional anesthesiologists and regional anesthesia fellows are benign in nature and occur frequently. Severe complications of regional anesthesia are far less commonly disclosed. The incidences of severe complications disclosed by academic regional anesthesiologists and their fellows can be inconsistent with those cited in the contemporary literature.
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Reg Anesth Pain Med · Jan 2007
An assessment tool for brachial plexus regional anesthesia performance: establishing construct validity and reliability.
Technical proficiency in regional anesthesia is often determined subjectively through in-training evaluations. Objective assessment tools improve these evaluations by providing criteria for measurement. However, any evaluation instrument needs to be valid and reliable before it is adopted into a curriculum. The purpose of this study is to determine the validity and reliability of a devised assessment of residents performing an interscalene brachial plexus block (ISB). ⋯ Both assessment modalities were valid, in that they reliably discriminated between different levels of training. Objective measures of technical skills are feasible, timely, and improve the validity and reliability of competency assessments.
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Reg Anesth Pain Med · Jan 2007
Uniform distribution of skin-temperature increase after different regional-anesthesia techniques of the lower extremity.
Skin-temperature increase is a reliable but late indicator of success during regional-anesthesia techniques. The goal of this study is to determine the distribution of skin-temperature changes during different regional techniques. Does skin temperature increase in the whole area innervated by the blocked neural structures or only in certain regions within this area with the capability to react preferentially to sympathetic block (i.e., vessel-rich skin)? Although onset time may vary between different regional-anesthetic techniques, we hypothesized that the distribution of skin warming is equal. ⋯ Irrespective of the applied regional-anesthetic technique, skin-temperature changes are more pronounced distally. Thermography prevents false measurements of skin temperature above subcutaneous veins and displays flow of cold blood as the mechanism of initial skin-temperature drop after regional anesthesia. Measurements of skin-temperature increase cannot be used to evaluate the extent of analgesia or sympathetic block.