Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled Trial Comparative StudyA prospective, randomized comparison between single- and double-injection, ultrasound-guided supraclavicular brachial plexus block.
This prospective, randomized, observer-blinded study compared single- and double-injection, ultrasound-guided supraclavicular brachial plexus block for upper extremity surgery. ⋯ The double-injection, ultrasound-guided supraclavicular block provides no significant advantages compared with its single-injection counterpart.
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled Trial Multicenter Study Comparative StudyEffect on neurostimulation of injectates used for perineural space expansion before placement of a stimulating catheter: normal saline versus dextrose 5% in water.
We clinically assessed the electrophysiologic effect of dextrose 5% in water (D5W) and of normal saline (NS) used for expansion of the perineural space before placing a stimulating catheter. We questioned if higher current was required with NS but not with D5W, as has been observed experimentally. ⋯ The current needed to electrostimulate the femoral or sciatic nerve was higher after injection of NS than after D5W.
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Reg Anesth Pain Med · Sep 2009
ReviewUltrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures: part I: nonaxial structures.
Application of ultrasound in pain medicine is a rapidly growing medical field in interventional pain management. Ultrasound provides direct visualization of various soft tissues and real-time needle advancement and avoids exposing both the health care provider and the patient to the risks of radiation. The machine itself is more affordable than a fluoroscope, computed tomography scan, or magnetic resonance imaging machine. In the present review, we discuss the challenges and limitations of ultrasound-guided procedures for pain management, anatomy, and sonoanatomy of selected pain management procedures and the literature on those selected procedures.
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled TrialUltrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis.
Interscalene brachial plexus block is associated with 100% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether an ultrasound (US)-guided interscalene brachial plexus block performed at the level of root C7 versus a nerve stimulation interscalene brachial plexus block, both using 10 mL of ropivacaine 0.75%, resulted in a lower incidence of hemidiaphragmatic paresis. ⋯ Ultrasound-guided interscalene brachial plexus block performed at the level of root C7 using 10 mL of ropivacaine 0.75% reduces the incidence of hemidiaphragmatic paresis.
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Reg Anesth Pain Med · Sep 2009
Comparative StudyDevelopment and validation of a new technique for ultrasound-guided stellate ganglion block.
Although the stellate ganglion is located anteriorly to the first rib, anesthetic block is routinely performed at the C6 level. Ultrasonography allegedly improves accuracy of needle placement and spread of injectate. The technique is relatively new, and the optimal approach has not been determined. Moreover, the location of the cervical sympathetic trunk relative to the prevertebral fascia is debatable. ⋯ This study revealed that, at the C6 level, the cervical sympathetic trunk lies entirely subfascially. Subfascial injection via the lateral approach ensures reliable spread of a solution to the stellate ganglion.