Regional anesthesia and pain medicine
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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
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.
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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.