Regional anesthesia and pain medicine
-
Suprascapular nerve blockade (SSNB) is a simple and safe technique for providing relief from various types of shoulder pain, including rheumatologic disorders, cancer, and trauma pain, and postoperative pain due to shoulder arthroscopy. Posterior, superior, and anterior approaches may be used, the most common being the posterior. ⋯ The different techniques of SSNB and indications for SSNB will be discussed. The complications of SSNB and outcomes of SSNB on the management of acute and chronic shoulder pain will be reviewed.
-
Reg Anesth Pain Med · Jul 2011
Randomized Controlled Trial Comparative StudyLateral versus medial needle approach for ultrasound-guided supraclavicular block: a randomized controlled trial.
When performing a supraclavicular brachial plexus block (SCB) under ultrasound (US) guidance, the needle may approach the nerves in-plane with the US beam from 1 of 2 directions relative to the transducer, lateral-to-medial (lateral) or medial-to-lateral (medial). We aimed to compare the rates of sensory and motor block of the 4 major peripheral nerves of the upper extremity following a lateral or medial needle approach for US-guided SCB. ⋯ The rates of sensory and motor block of all 4 major peripheral nerves of the upper extremity did not differ at any time following a lateral compared with medial needle approach for US-guided SCB. Regardless of needle approach, the rate of ulnar nerve sensory block was less compared with the other peripheral nerves following US-guided SCB.
-
Reg Anesth Pain Med · Jul 2011
Randomized Controlled Trial Comparative StudyDeveloping effective web-based regional anesthesia education: a randomized study evaluating case-based versus non-case-based module design.
Little is known about the use of Web-based education in regional anesthesia training. Benefits of Web-based education include the ability to standardize learning material quality and content, build appropriate learning progressions, use interactive multimedia technologies, and individualize delivery of course materials. The goals of this investigation were (1) to determine whether module design influences regional anesthesia knowledge acquisition, (2) to characterize learner preference patterns among anesthesia residents, and (3) to determine whether learner preferences play a role in knowledge acquisition. Direct comparison of knowledge assessments, learning styles, and learner preferences will be made between an interactive case-based and a traditional textbook-style module design. ⋯ All residents scored higher on the postmodule knowledge assessment, but this improvement was independent of the module design and individual learning styles. Although residents believe that online learning should be used in anesthesia training, the results of this study do not demonstrate improved learning or justify the time and expense of developing complex case-based training modules. While there may be practical benefits of Web-based education, educators in regional anesthesia should be cautious about developing curricula based on learner preference data.
-
Perioperative nerve injuries are devastating complications that are commonly attributed to a variety of patient, surgical, or anesthetic factors. Well-documented causes of postsurgical neuropathy include nerve compression, stretch, contusion, or transection, which can occur following surgical trauma or patient positioning. Potential anesthetic causes of perioperative nerve injury include mechanical trauma, local anesthetic toxicity, and ischemic injury. We present a case of a diffuse, bilateral neurologic deficit of unclear etiology in a patient who underwent a combined neuraxial-general anesthetic for bilateral total hip arthroplasty. ⋯ Perioperative nerve deficits not readily explained by direct surgical or anesthesia-related causes should prompt early neurologic consultation to seek alternative etiologies such as postsurgical inflammatory neuropathy. Although this condition is poorly understood, it is believed to be an idiopathic immune-mediated response to a physiologic stress (eg, surgery, regional block) and is treated with prolonged, high-dose corticosteroids. Because suppression of the immune system with high-dose steroids may result in improved neurologic outcome, it is essential that surgeons and anesthesiologists are aware of this condition so that treatment is not delayed.
-
Reg Anesth Pain Med · Jul 2011
Comparative StudyPatient perceptions of regional anesthesia: influence of gender, recent anesthesia experience, and perioperative concerns.
Anesthesiologists often find that patients would prefer a general anesthetic (GA) to a regional anesthetic (RA) for surgery. We surveyed patients' attitudes to RA in an Australian tertiary-care hospital, hoping to understand the reasons for acceptance or refusal. We explored how 3 main factors influence the patient's choice for subsequent RA: gender, type of anesthetic on the day of surgery, and perioperative concerns. ⋯ More patients, especially females, may accept RA if reassured appropriately about not hearing or seeing the surgery. Once patients have experienced RA, they are more likely to choose it in future. Modification of our discussion and consent process may increase the uptake of RA techniques.