Regional anesthesia and pain medicine
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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
Case ReportsThe role of a preprocedure systematic sonographic survey in ultrasound-guided regional anesthesia.
The presence of neurovascular abnormalities may increase the risk of complications following regional anesthesia techniques. Use of conventional nerve localization methods may fail to detect such abnormalities and potentially result in block failure and/or unintentional neurovascular injury. ⋯ We believe that a systematic sonographic survey prior to regional anesthesia can be a valuable bedside screening tool to assess the suitability and challenges involved in performing US-guided peripheral nerve block.