Regional anesthesia and pain medicine
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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.
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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.
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Reg Anesth Pain Med · Jul 2011
Case ReportsRecognition of an incidental abscess and a hematoma during ultrasound-guided femoral nerve block.
Ultrasound guidance for femoral nerve blockade allows visualization of normal and abnormal anatomy. Two cases of femoral nerve blockade under ultrasound guidance are presented where a major perineural pathologic lesion was incidentally revealed. ⋯ We review and discuss incidental pathologic lesions that can be found in the femoral region. Identification of these 2 pathologic lesions facilitated our perioperative management strategies in two separate cases.
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Reg Anesth Pain Med · Jul 2011
Comparative StudyDo diagnostic blocks have beneficial effects on pain processing?
Diagnostic blocks of cervical zygapophysial joints have been used as part of the management strategy for patients with chronic neck pain. Little information is available regarding the sensory processing changes that occur after these common procedures. In a hypothesis-generating prospective study, the pressure-pain thresholds, electrical pain thresholds, and descending inhibitory modulation response using the conditioned pain modulation paradigm are described for 9 patients with cervical zygapophysial joint pain that underwent successful comparative diagnostic blocks. ⋯ Our preliminary evidence suggests that the perturbations to the sensory processing system from effective diagnostic blocks affect the tonic inhibitory system in a positive manner. Conditioned pain modulation, however, needs to be interpreted in the context of altered pain thresholds, and future studies should aim to investigate the shift in the nociceptive balance between facilitatory and inhibitory control after therapeutic interventions.
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Reg Anesth Pain Med · Jul 2011
Comparative StudyAnatomy and clinical implications of the ultrasound-guided subsartorial saphenous nerve block.
We evaluated the anatomic basis and the clinical results of an ultrasound-guided saphenous nerve block close to the level of the nerve's exit from the inferior foramina of the adductor canal. ⋯ Ultrasound-guided injection directly caudally from the inferior foramina of the adductor canal, between the sartorius muscle and the femoral artery, seems to be an effective approach for saphenous nerve block.