Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2008
Case ReportsLong-axis ultrasound imaging of the nerves and advancement of perineural catheters under direct vision: a preliminary report of four cases.
Ultrasound allows visualization of in plane needle insertion toward a nerve and the perineural spread of local anesthetic (LA) solution. However, advancement and final positioning of perineural catheters is difficult to visualize. We assessed the feasibility of long axis nerve scans for controlling perineural catheter placement. ⋯ This short case series suggests that long axis imaging of the nerve, the needle, and the catheter allows visualization of a catheter's advancement. Using to-and-fro movements, and slight rotation the needle's bevel, the catheter may be maneuvered under the ultrasound beam, which facilitates correct positioning.
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Reg Anesth Pain Med · Sep 2008
Practice patterns related to block selection, nerve localization and risk disclosure: a survey of the American Society of Regional Anesthesia and Pain Medicine.
We aimed to identify current clinical practice patterns among members of the American Society of Regional Anesthesia and Pain Medicine (ASRA) members that relate to complications of regional anesthesia (RA). ⋯ Based on a 22% response rate, our survey suggests that the risks of RA most commonly disclosed to patients by ASRA members are benign while severe complications of RA are far less commonly disclosed. There is little agreement among ASRA members regarding their perceived incidence of complications following RA.
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Reg Anesth Pain Med · Sep 2008
Biography Historical ArticleCentennial of intravenous regional anesthesia. Bier's Block (1908-2008).
The surgeon August Gustav Bier significantly influenced surgery, general medicine, and especially anesthesia. He was the father of spinal anesthesia (1898) and intravenous regional anesthesia (1908). ⋯ On the occasion of the centennial anniversary of the first use of intravenous regional anesthesia it is appropriate to recall Bier's contribution to the repertoire of anesthesiologists. The evolutionary history of both the injected drugs and the refinements of the technique are elaborated upon.
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A peripheral nerve or spinal cord injury is a rare but significant complication of regional anesthesia. Evaluation of acute nerve injury includes a focused history and examination to localize the lesion. Confirmatory testing should include electromyography and appropriate imaging. ⋯ The prognosis for cauda equina or spinal cord lesions is more guarded. Recovery from these is commonly incomplete. Early diagnosis and intervention is the key to preventing catastrophic neurological outcomes.
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Reg Anesth Pain Med · Sep 2008
Comment Letter Case ReportsEight ball, corner pocket ultrasound-guided supraclavicular block: avoiding a scratch.