Regional anesthesia and pain medicine
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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
A pre-emptive multimodal pathway featuring peripheral nerve block improves perioperative outcomes after major orthopedic surgery.
Patients undergoing major orthopedic surgery experience significant postoperative pain. Failure to provide adequate analgesia may impede early physical therapy and rehabilitation, which are important factors for maintaining joint range of motion and facilitating hospital dismissal. We examined the effect of a pre-emptive, multimodal, perioperative analgesic regimen emphasizing peripheral nerve block in patients undergoing total hip (THA) and total knee (TKA) arthroplasty. Perioperative outcomes and major postoperative complications were evaluated. ⋯ Patients undergoing THA or TKA using a comprehensive, pre-emptive, multimodal analgesic regimen emphasizing peripheral nerve block may have significantly improved perioperative outcomes, and fewer adverse events, when compared with patients receiving traditional intravenous opioids during the initial postoperative period. Improved perioperative outcomes include a shortened hospital length of stay, and a significant reduction in postoperative urinary retention and ileus formation.
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Reg Anesth Pain Med · Nov 2008
An ultrasound study of the phrenic nerve in the posterior cervical triangle: implications for the interscalene brachial plexus block.
Concomitant phrenic nerve block frequently occurs after brachial plexus block procedures in the neck and can result in substantial morbidity. In this study we sought to establish the anatomic basis using ultrasound imaging. ⋯ This descriptive study found that the phrenic nerve and brachial plexus are within 2 mm of each other at the cricoid cartilage level, with additional 3 mm separation for every cm more caudal in the neck. Clinical trials with imaging guidance are needed to establish whether brachial plexus selective blocks can be consistently achieved above the clavicle.
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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.