Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2009
Minimal local anesthetic volume for peripheral nerve block: a new ultrasound-guided, nerve dimension-based method.
Nerve blocks using local anesthetics are widely used. High volumes are usually injected, which may predispose patients to associated adverse events. Introduction of ultrasound guidance facilitates the reduction of volume, but the minimal effective volume is unknown. In this study, we estimated the 50% effective dose (ED50) and 95% effective dose (ED95) volume of 1% mepivacaine relative to the cross-sectional area of the nerve for an adequate sensory block. ⋯ Based on the ultrasound measured cross-sectional area and using ultrasound guidance, a mean volume of 0.7 mL represents the ED95 dose of 1% mepivacaine to block the ulnar nerve at the proximal forearm.
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Reg Anesth Pain Med · May 2009
Vertical infraclavicular brachial plexus block: needle redirection after elicitation of elbow flexion.
In vertical infraclavicular brachial plexus block, success depends on distal flexion or extension response. Initially, elbow flexion (lateral cord) is generally observed. However, specific knowledge about how to reach the medial or posterior cord is lacking. We investigated the mid-infraclavicular area in undisturbed anatomy and tested the findings in a clinical setting. ⋯ In the clinical study, in 98% of cases, the final stimulation response of posterior or medial cord was found as predicted by the findings of the anatomic study. Once elbow flexion is elicited, a further (ie, deeper) advancement of the needle will result in the proper distal motor response.
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Reg Anesth Pain Med · May 2009
Editorial CommentSacroiliac joint radiofrequency denervation: who benefits?
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Reg Anesth Pain Med · May 2009
Randomized Controlled Trial Comparative StudyUltrasound improves the success rate of a tibial nerve block at the ankle.
The tibial nerve provides the majority of sensation to the foot. Although multiple techniques have been described, there exists little evidence-based medicine evaluating different techniques for blocking the tibial nerve at the ankle. We hypothesized that an ultrasound (US)-guided tibial nerve block at the ankle would prove more successful than a conventional approach based on surface landmarks. ⋯ In healthy volunteers, US guidance results in a more successful tibial nerve block at the ankle than does a traditional approach using surface landmarks.