Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Jul 2009
Randomized Controlled Trial Comparative StudyParavertebral block in inguinal hernia surgeries: two segments or 4 segments?
In this study, we compare paravertebral block (PVB) of the T10 and L1 segments and multiple-segment PVB for anesthesia and analgesia in inguinal hernia surgeries. ⋯ Two-segment PVB can be an alternative to 4-segment PVB in inguinal hernia surgeries. Decreasing the number of injections required in this technique may further increase patient comfort and decrease complications.
-
Reg Anesth Pain Med · Jul 2009
Ultrasound-guided cervical selective nerve root block: a fluoroscopy-controlled feasibility study.
Reports of intravascular injection during cervical transforaminal injections, even after confirmation by contrast fluoroscopy, have led some to question the procedure's safety. As ultrasound allows for visualization of soft tissues, nerves, and vessels, thus potentially improving precision and safety, we evaluated its feasibility in cervical nerve root injections. ⋯ Our case series shows the feasibility of using ultrasound imaging to guide selective cervical nerve root injections. It may facilitate identifying critical vessels at unexpected locations relative to the intervertebral foramen and avoiding injury to such vessels, which is the leading cause of the reported complications from cervical nerve root injections. A randomized controlled trial to compare the effectiveness and safety of ultrasound imaging against other imaging techniques seems warranted.
-
Reg Anesth Pain Med · Jul 2009
Comparative StudyThe economic implications of a multimodal analgesic regimen for patients undergoing major orthopedic surgery: a comparative study of direct costs.
Total knee and total hip arthoplasty (THA) are 2 of the most common surgical procedures performed in the United States and represent the greatest single Medicare procedural expenditure. This study was designed to evaluate the economic impact of implementing a multimodal analgesic regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing lower extremity joint replacement surgery. ⋯ Use of a comprehensive, multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement surgery provides a significant reduction in the estimated total direct medical costs. The reduction in mean cost is primarily associated with lower hospital-based (Medicare Part A) costs, with the greatest overall cost difference appearing among patients with significant comorbidities (ASA PS III-IV patients).
-
Reg Anesth Pain Med · Jul 2009
Prevalence and risk factors predisposing to coagulopathy in patients receiving epidural analgesia for hepatic surgery.
Patients undergoing liver resection may have marginal preoperative liver function, extensive intraoperative blood loss, and perioperative hepatic dysfunction. We evaluated the prevalence and types of coagulopathic conditions that occur in patients with epidural catheters undergoing hepatic resection. ⋯ A high prevalence of hemostatic abnormalities in patients undergoing major hepatic resection while receiving epidural analgesia occurred. Important considerations may include discussion with the surgical team, measuring coagulation, and heightened clinical monitoring in the postoperative period.