Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2011
Randomized Controlled Trial Comparative StudyIs circumferential injection advantageous for ultrasound-guided popliteal sciatic nerve block?: A proof-of-concept study.
Ultrasound (US) guidance, in some instances, can increase the success rate and reduce the onset and procedure times for peripheral nerve blockade compared with traditional nerve localization techniques. The presumptive mechanism for these benefits is the ability to accurately inject local anesthetic circumferentially around the target nerve. We aimed to determine whether ensuring circumferential spread of local anesthetic is advantageous for US-guided popliteal sciatic nerve block. ⋯ Ultrasound-guided circumferential injection of local anesthetic around the sciatic nerve at the popliteal fossa can improve the rate of sensory block without an increase in block procedure time or block-related complications compared with a single-location injection technique.
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Reg Anesth Pain Med · May 2011
Comparative StudyHand motion analysis using the imperial college surgical assessment device: validation of a novel and objective performance measure in ultrasound-guided peripheral nerve blockade.
The Imperial College Surgical Assessment Device (ICSAD) has been validated in various settings as an objective tool to measure technical performance. We sought to establish (1) the construct validity of the ICSAD as an assessment tool in ultrasound-guided supraclavicular block by determining its ability to discriminate between operators of different experience level and (2) the concurrent validity of the ICSAD by correlating it with a task-specific checklist and a global rating scale. ⋯ The ICSAD is both valid and useful in assessing performance of ultrasound-guided supraclavicular block.
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Reg Anesth Pain Med · May 2011
Comparative StudyUncomplicated removal of epidural catheters in 4365 patients with international normalized ratio greater than 1.4 during initiation of warfarin therapy.
Current guidelines from the American Society of Regional Anesthesia state that an international normalized ratio (INR) of 1.4 is the upper limit of warfarin anticoagulation for safe removal of an epidural catheter. However, these guidelines are based primarily on expert consensus, and there is controversy regarding this recommendation as being "too conservative." ⋯ Our series of 4365 patients had uncomplicated removal of epidural catheters despite INRs ranging from 1.5 to 5.9. Removal was only during initiation of warfarin therapy (up to approximately 50 hrs after warfarin intake) when several vitamin K factors are likely to still be adequate for hemostasis.