Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Comparative StudyPsoas compartment block for acute postoperative pain management after hip surgery in pediatrics: a comparative study with caudal analgesia.
Lower-limb peripheral nerve blocks in pediatrics have gained much more popularity in the last few decades. Our purpose of this study was to compare the postoperative analgesic effects between psoas compartment block (PCB) and caudal block in small children undergoing open hip reduction/osteotomies. ⋯ Use of single-shot PCB is superior to single-shot caudal block regarding length of postoperative analgesia and cumulative dose of morphine in small children undergoing open hip reduction/osteotomies.
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Reg Anesth Pain Med · Mar 2011
Comparative StudyNewly designed, self-coiling catheters for regional anesthesia--an imaging study.
A major concern with the use of continuous peripheral nerve block is the difficulty encountered in placing the catheters close enough to the nerves to accomplish effective analgesia. The aim of this study was to investigate if a self-coiling catheter would remain close to the sciatic nerve once introduced through needles placed under ultrasound guidance and if contrast dye injected through the pigtail catheter made direct contact to the nerves. ⋯ By using self-coiling catheters, it is possible to blindly introduce the catheter through needles placed under ultrasound guidance with a low risk of catheter misplacement away from the targeted nerves.
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Reg Anesth Pain Med · Mar 2011
Comparative StudyTensile strength decreases and perfusion pressure of 3-holed polyamide epidural catheters increases in long-term epidural infusion.
Epidural analgesia is an established method for pain management. The failure rate is 8% to 12% due to technical difficulties (catheter dislocation and/or disconnection; partial or total catheter occlusion) and management. The mechanical properties of the catheters, like tensile strength and flow rate, may also be affected by the analgesic solution and/or the tissue environment. ⋯ Epidural catheter use significantly increases the perfusion pressure and decreases the tensile strength.
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Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Comparative StudyPosterior versus anterolateral approach interscalene catheter placement: a prospective randomized trial.
Two distinctly different approaches to interscalene catheter placement have been in common use for close to a decade. This prospective randomized study tested the hypothesis that interscalene catheters placed using the posterior approach would provide a more effective analgesia after shoulder surgery compared with catheters placed using the anterolateral approach. ⋯ Anterolateral interscalene catheters perform more effectively and are procedurally more easily placed compared with catheters placed using the posterior approach.
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Reg Anesth Pain Med · Mar 2011
ReviewA review of the benefits and pitfalls of phantoms in ultrasound-guided regional anesthesia.
With the growth of ultrasound-guided regional anesthesia, so has the requirement for training tools to practice needle guidance skills and evaluate echogenic needles. Ethically, skills in ultrasound-guided needle placement should be gained in a phantom before performance of nerve blocks on patients in clinical practice. However, phantom technology is varied, and critical evaluation of the images is needed to understand their application to clinical use. ⋯ Fresh-frozen cadavers retain much of the textural feel of live human tissue and are nearly as echogenic. Similar to clinical practice, this makes needles inserted at steep angles practically invisible, unless they are highly echogenic. This review describes the uses and pitfalls of phantoms that have been described or commercially produced.