Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Jul 2010
ReviewUltrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures. Part II: axial structures.
There is a growing trend in using ultrasonography in pain medicine as evident by the plethora of published reports. Ultrasound(US) 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. ⋯ In a previous review, we discussed the challenges and limitations of US, anatomy, sonoanatomy, and techniques of interventional procedures of peripheral structures. In the present review, we discuss the anatomy, sonoanatomy, and US-guided techniques of interventional pain procedures for axial structures and review the pertinent literature.
-
Reg Anesth Pain Med · Jul 2010
Randomized Controlled TrialUltrasound provides a reliable test of local anesthetic spread.
We predicted that practitioners could identify injectate spread in a model of ultrasound-guided peripheral nerve block. ⋯ This study shows that ultrasound is a reliable method of detecting injectate spread in a gelatin phantom model.
-
Reg Anesth Pain Med · Jul 2010
Local anesthetic sciatic nerve block and nerve fiber damage in diabetic rats.
A concern for anesthesiologists is whether local anesthetics are more toxic to peripheral nerves in diabetic patients. A previous study in streptozotocin-induced diabetic rats showed that larger doses of lidocaine produce moderate nerve injury after nerve block in normal rats and worse injury in diabetic rats. However, it is not clear whether a smaller local anesthetic dose that produces negligible nerve fiber damage in normal rats will produce significant nerve damage in diabetic rats and if adding adjuvant drugs modulates this effect. ⋯ The duration of sciatic nerve block with local anesthetics is longer in diabetic compared with nondiabetic rats. A small, but statistically significant, increase in nerve damage occurred in diabetic rats after nerve block with ropivacaine alone or when duration of lidocaine block was extended with clonidine. These findings may have implications for dosing of local anesthetics in diabetic patients undergoing regional analgesia with nerve blocks.
-
Reg Anesth Pain Med · Jul 2010
Case ReportsNerve injury complicating ultrasound/electrostimulation-guided supraclavicular brachial plexus block.
Neurologic complications after peripheral nerve blocks (PNBs) are relatively uncommon. It has been postulated that real-time, needle-nerve visualization during ultrasound guided PNBs might further reduce the risk of neurologic or vascular complications. ⋯ Ultrasound guidance should not preclude development of additional monitoring and protocols to decrease the risk of complications with PNBs.