Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2009
Multicenter StudyVarious possible positions of conventional catheters around the femoral nerve revealed by neurostimulation.
In continuous femoral nerve blocks, the various perineural positions of the tip of a conventional catheter and their clinical implication are not completely known.We used stimulating catheters to explore the relationship of catheter tip to nerve. ⋯ The effectiveness of a continuous femoral block depends on neurostimulation characteristics, which likely correspond to various possible catheter tip positions. Conventional catheters provide no information on this issue. These results suggest that better VAS scores are attainable by placing catheters with neurostimulation guidance.
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Reg Anesth Pain Med · Jul 2009
Randomized Controlled TrialA prospective, randomized comparison between ultrasound-guided supraclavicular, infraclavicular, and axillary brachial plexus blocks.
This prospective, randomized, observer-blinded study compared ultrasound-guided supraclavicular (SCB), infraclavicular (ICB), and axillary (AXB) brachial plexus blocks for upper extremity surgery of the elbow, forearm, wrist, and hand. ⋯ Adjunctive ultrasonography results in similar success rates, total anesthesia-related times, and block-related pain scores for the SCB, ICB, and AXB.
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Reg Anesth Pain Med · Jul 2009
Ultrasound-guided lumbar medial branch block in obese patients: a fluoroscopically confirmed clinical feasibility study.
Obesity is a major risk factor for lower back pain. Fluoroscope-guided medial branch block is a common diagnostic tool in these patients. Although approach to the facet joint guided by ultrasound has been demonstrated successfully in lean patients, its success in obese patients is unknown.We therefore evaluated the success rate of real-time ultrasound approach in obese patients in a clinical feasibility study. ⋯ Medial branch blocks in obese patients cannot be performed by ultrasound guidance exclusively.
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The perception of high resistance during injection of a local anesthetic during regional anesthesia may indicate intraneural injection. Anesthetists' ability to detect high resistance by "syringe feel" has been questioned in the past. The aim of our study was to investigate the anesthetist's ability to detect abnormal resistance to injection using an animal model. ⋯ Under the conditions of this study model, anesthetists were unable to correctly identify intraneural injection by syringe feel during simulated regional anesthesia.