Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2009
ReviewFuture considerations for pharmacologic adjuvants in single-injection peripheral nerve blocks for patients with diabetes mellitus.
As the epidemics of obesity and diabetes expand, there are more patients with these disorders requiring elective surgery. For surgery on the extremities, peripheral nerve blocks have become a highly favorable anesthetic option when compared with general anesthesia. Peripheral blocks reduce respiratory and cardiac stresses, while potentially mitigating untreated peripheral pain that can foster physiologic conditions that increase risks for general health complications. ⋯ This is important because anesthesiologists do not want to potentially accelerate peripheral nerve dysfunction in diabetic patients at risk. This translational vignette (i) examines laboratory models of diabetes, (ii) summarizes the pharmacology of perineural adjuvants (epinephrine, clonidine, buprenorphine, midazolam, tramadol, and dexamethasone), and (iii) identifies areas that warrant further research to determine viability of monotherapy or combination therapy for peripheral nerve analgesia in diabetic patients. Conceivably, future translational research regarding peripheral nerve blocks in diabetic patients may logically include study of nontoxic injectable analgesic adjuvants, in combination, to provide desired analgesia, while possibly avoiding peripheral nerve toxicity that diabetic animal models have exhibited when exposed to traditional local anesthetics.
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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
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
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
Sonographic location of the radial nerve confirmed by nerve stimulation during axillary brachial plexus blockade.
: Visualization of the radial nerve can be a challenge during ultrasound-guided axillary blockade. The objective of this study was to plot the location and examine the sonographic appearance of the radial nerve in the axilla using both ultrasound visualization and nerve stimulator verification in patients undergoing axillary blockade. ⋯ : The radial nerve uncommonly lies immediately deep to the axillary artery. It is frequently located on the caudad side of the artery.