Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2008
Comparative StudyFeasibility of ultrasound-guided percutaneous placement of peripheral nerve stimulation electrodes and anchoring during simulated movement: part two, upper extremity.
Peripheral nerve stimulation (PNS) may provide analgesia for neuropathic pain syndromes in that nerve distribution. PNS electrode placement using ultrasound (US) guidance for upper extremity pain syndromes has not been reported. Existing anchoring technology may allow permanent implantation without significant migration. ⋯ This new minimally invasive approach to lead placement requires further study to determine implantation criteria, optimal locations, anchoring techniques, and electrode design to define best clinical practice.
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Reg Anesth Pain Med · Nov 2008
ReviewNeedle visualization in ultrasound-guided regional anesthesia: challenges and solutions.
Needle visualization is important for safe and successful ultrasound-guided peripheral nerve block. However, accurate and consistent visualization of the needle tip can be difficult to achieve. This review article describes many of the challenges affecting needle visualization, summarizes the relevant literature on ultrasound imaging of needles, and offers practical strategies for improving needle tip visibility. Finally, future directions for research and development are suggested.
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Reg Anesth Pain Med · Nov 2008
Feasibility of ultrasound-guided percutaneous placement of peripheral nerve stimulation electrodes in a cadaver model: part one, lower extremity.
Peripheral nerve stimulation (PNS) is analgesic for some lower extremity neuropathic pain syndromes. PNS currently involves open surgical placement of electrode(s). Increasingly, ultrasound guidance is used for perioperative neural block. Minimally invasive placement of PNS electrodes for lower extremity targets using ultrasound guidance has not been reported. We hypothesized that ultrasound-guided placement of PNS electrodes was feasible. ⋯ Ultrasound imaging to facilitate peripheral nerve electrode placement is feasible. This new minimally invasive approach to lead placement requires further study to determine trial implantation criteria, optimal locations, anchoring techniques, and best clinical practice.
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Reg Anesth Pain Med · Nov 2008
Randomized Controlled Trial Multicenter StudyEffects of local anesthetic concentration and dose on continuous interscalene nerve blocks: a dual-center, randomized, observer-masked, controlled study.
It is currently unknown if the primary determinant of continuous peripheral nerve block effects is simply total drug dose, or whether local anesthetic concentration and/or volume have an influence. We therefore tested the null hypothesis that providing ropivacaine at different concentrations and rates--but at an equal total basal dose--produces similar effects when used in a continuous interscalene nerve block. ⋯ For continuous interscalene nerve blocks, given the statistically inconclusive primary endpoint results and design limitations of the current study, further research on this topic is warranted. In contrast, providing a lower concentration of local anesthetic at a higher basal rate provided superior analgesia.
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Reg Anesth Pain Med · Nov 2008
Randomized Controlled Trial Comparative StudyUltrasound guided fascia iliaca block: a comparison with the loss of resistance technique.
The aim of this study was to compare the efficacy of fascia iliaca block, performed by loss of resistance and ultrasound guidance techniques. ⋯ Ultrasound-guided fascia iliaca block increased the frequency of sensory loss in the medial aspect of the thigh. Ultrasound guidance also increased the frequency of femoral and obturator motor block.