Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2009
Anatomic basis to the ultrasound-guided approach for saphenous nerve blockade.
Successful blockade of the saphenous nerve using surface landmarks can be challenging. We evaluated the anatomic basis of performing a saphenous nerve block with ultrasound (US) using its relationship to the saphenous branch of descending genicular artery, sartorius muscle, and the adductor hiatus as defined by cadaveric measurements. ⋯ The US-guided approach for saphenous nerve blockade using its close anatomic relationship to the SBDGA is a feasible alternative to previously described surface landmark-based or US-guided paravenous approaches.
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled Trial Comparative StudyPercutaneous upper thoracic radiofrequency sympathectomy in Raynaud phenomenon: a comparison of T2/T3 procedure versus T2 lesion with phenol application.
Percutaneous radiofrequency (RF) thoracic sympathectomy is an alternative method to surgical procedures for the treatment of acral ischemia in Raynaud phenomenon. The procedure is indicated if conservative therapy fails to provide sufficient relief. The aim of this study was to compare classic T2 and T3 RF thermolesioning with a less invasive procedure at the level of T2 only. ⋯ Thoracic RF upper sympathectomy is an effective method in the treatment of resistant forms of Raynaud phenomenon. A single-shot procedure at the level of T2 may be preferable because of the shorter procedure duration of this technique.
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled Trial Comparative StudyElectrical stimulation versus ultrasound guidance for popliteal-sciatic perineural catheter insertion: a randomized controlled trial.
Sciatic perineural catheters via a popliteal fossa approach and subsequent local anesthetic infusion provide potent analgesia and other benefits after foot and ankle surgery. Electrical stimulation (ES) and, more recently, ultrasound (US)-guided placement techniques have been described. However, because these techniques have not been compared in a randomized fashion, the optimal method remains undetermined. Therefore, we tested the hypotheses that popliteal-sciatic perineural catheters placed via US guidance require less time for placement and produce equivalent results, as compared with catheters placed using ES. ⋯ Placement of popliteal-sciatic perineural catheters takes less time and produces less procedure-related discomfort when using US guidance compared with ES.
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Reg Anesth Pain Med · Sep 2009
Meningeal (postdural) puncture headache, unintentional dural puncture, and the epidural blood patch: a national survey of United States practice.
Meningeal (postdural) puncture headache (MPH) is a familiar iatrogenic complication. The optimal means of prevention, management, and treatment of this disorder are uncertain. The purpose of this study was to determine current practice among United States (USA) anesthesiologists regarding MPH as well as the related issues of unintentional dural puncture (UDP), the epidural blood patch (EBP), and proposed alternatives to the EBP. ⋯ Various measures, many poorly supported by the literature, are used prophylactically after UDP and in the treatment of MPH. Despite being nearly universally used as treatment of MPH, the EBP procedure itself remains largely nonstandardized.
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Reg Anesth Pain Med · Sep 2009
Letter Case ReportsUltrasound-guided infraclavicular nerve block and the cephalic vein.