Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2010
Nerve expansion seen on ultrasound predicts histologic but not functional nerve injury after intraneural injection in pigs.
Intraneural injection can be seen as nerve expansion during ultrasound-guided regional anesthesia. The purpose of this animal study was to determine if nerve expansion seen on ultrasound during intraneural injection results in nerve injury. ⋯ This animal study suggests that nerve expansion seen on ultrasound during intraneural injection of clinically relevant volumes of LA results in histologic but not functional nerve injury.
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Reg Anesth Pain Med · Mar 2010
ReviewModels and mechanisms of local anesthetic cardiac toxicity: a review.
Cardiovascular collapse, even death, may occur after intoxication with bupivacaine or related amide local anesthetic agents. The problem has been studied in myriad laboratories for more than 20 years. Nevertheless, there is consensus neither regarding which animal model best mimics this clinical catastrophe nor as to which ion channel, enzyme, or other local anesthetic binding site represents the point of initiation for the process. This review aimed to define the various credible mechanisms that have been proposed to explain cardiovascular collapse and death after administration of local anesthetics, particularly after bupivacaine and related agents.
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Reg Anesth Pain Med · Mar 2010
Practice GuidelineThe American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy joint committee recommendations for education and training in ultrasound-guided regional anesthesia.
Ultrasound-guided regional anesthesia (UGRA) is a growing area of both clinical and research interest. The following document contains the work produced by a joint committee from ASRA and the European Society of Regional Anesthesia and Pain Therapy. This joint committee was established to recommend to members and institutions the scope of practice, the teaching curriculum, and the options for implementing the medical practice of UGRA. ⋯ In both the residency and postgraduate pathways, training, competency, and proficiency requirements include both didactic and experiential components. The Joint Committee recommends that the decision to grant UGRA privileges be based at the individual institution level. Each institution that conducts UGRA is encouraged to support a productive quality improvement process.
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Reg Anesth Pain Med · Mar 2010
Spinal Anesthesia and Intrathecal Clonidine Decrease the Hypnotic Requirement of Propofol.
Spinal anesthesia and intrathecal clonidine are known to have hypnotic effects. We investigated the effect of spinal anesthesia and intrathecal clonidine on the requirement of propofol for sedation. ⋯ Spinal anesthesia and intrathecal clonidine might reduce the requirement of propofol for sedation. Our study showed target concentrations of propofol for sedation of 1.4 to 1.7 using local anesthesia only, 1.1 to 1.4 using spinal anesthesia with bupivacaine, and 0.7 to 0.9 microg/mL using spinal anesthesia with bupivacaine and 75 microg of clonidine
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Reg Anesth Pain Med · Mar 2010
In-plane ultrasound-guided thoracic paravertebral block: a preliminary report of 36 cases with radiologic confirmation of catheter position.
Thoracic paravertebral block (TPVB) can be used for unilateral surgical procedures. Modifications of the classic approach have been proposed to minimize the risk of pleural puncture. In this study, we evaluated the feasibility and success rate of a transverse in-plane ultrasound (US)-guided TPVB with radiologic confirmation of catheter position. ⋯ An in-plane transverse US-guided TPVB using the described technique is feasible and has a high success rate. In all patients, correct catheter position in the thoracic paravertebral space was radiologically confirmed.