Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2009
Evaluation of the longus colli muscle in relation to stellate ganglion block.
The longus colli (LC) muscle is an important structure of the anterior cervical spine and has a critical role in stellate ganglion block. This technique involves withdrawing the needle to locate its port for injection above the anterior surface of the LC muscle; however, its exact thickness at the C5, C6, and C7 levels has not been measured. The aim of this anatomic and magnetic resonance-supported study was to evaluate the thickness of the LC muscle at these levels from the anterior tubercle of each vertebra toward the vertebral body at 5-, 10-, and 15-mm distances to provide precise anatomic data for stellate ganglion block. ⋯ We found a highly variable thickness of the LC muscle in anatomic and imaging studies, which may lead to negative block results.
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Reg Anesth Pain Med · May 2009
Multicenter StudyOutcome predictors for sacroiliac joint (lateral branch) radiofrequency denervation.
Sacroiliac (SI) joint pain is a challenging condition characterized by limited treatment options. Recently, numerous studies have reported excellent intermediate-term outcomes after lateral-branch radiofrequency (RF) denervation, but these studies are characterized by wide variability in technique, selection criteria, and patient characteristics. The purpose of this study was to determine whether any demographic or clinical variables can be used to predict SI joint RF denervation outcome. ⋯ Whereas several factors were found to influence outcome, no single clinical variable reliably predicted treatment results. The use of more stringent selection criteria was not associated with better outcomes.
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Reg Anesth Pain Med · May 2009
Comparative StudyAdverse outcomes associated with stimulator-based peripheral nerve blocks with versus without ultrasound visualization.
In this retrospective study, we queried our Quality Improvement database of anesthetic-related complications to evaluate the frequency of noncatheter peripheral nerve block-related adverse occurrences. We hypothesized that adverse complications of nerve blockade are less common when ultrasonography is used in conjunction with peripheral nerve stimulation to guide needle placement, when compared with the sole use of physical landmarks and nerve stimulation. ⋯ High-definition ultrasonography offers potential advantages in the administration of peripheral nerve blockade. The significant difference in major central nervous system local anesthetic toxicity observed in this study supports the use of ultrasound guidance in conjunction with peripheral nerve stimulation to provide brachial plexus peripheral nerve blockade in an academic, ambulatory anesthesia practice.
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Reg Anesth Pain Med · May 2009
Implications of a permanent cardiac pacemaker in peripheral nerve blockade.
Patients with permanent cardiac pacemakers (PPMs) are vulnerable to electromagnetic interference from electrical equipment used in the operating room environment. Electromagnetic interference may lead to PPM malfunction with potential harmful effects to the patient. ⋯ The hazards of NS, especially when applied near the implanted PPM sites, are not known. In the absence of available guidelines regarding the safe use of NS in the setting of an implanted PPM, we recommend a combined guidance approach for peripheral nerve blockade using ultrasound for nerve localization along with low-current NS for nerve identification.
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Reg Anesth Pain Med · May 2009
Comparative StudySpinal procaine is less neurotoxic than mepivacaine, prilocaine and bupivacaine in rats.
Lidocaine has been reported to be more neurotoxic than other local anesthetics. Alternatives to lidocaine with lower toxicity and shorter duration of action are desirable. Therefore, we compared the histologic and functional changes induced by intrathecal injection of prilocaine, mepivacaine, procaine, and bupivacaine in rats. ⋯ In this animal model, the neurotoxicity of intrathecal procaine was the mildest, and the recovery time to ambulation with procaine was the fastest among the 4 tested anesthetics.