Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2012
Randomized Controlled TrialA 3-dimensional ultrasound study of local anesthetic spread during lateral popliteal nerve block: what is the ideal end point for needle tip position?
Recent clinical trials suggest that subfascial (sometimes termed subepineural) injections result in faster block onset and success compared with conventional techniques. This prospective, randomized, observer-blinded study measured and compared the 3-dimensional spread pattern and volume of perineural local anesthetic (LA) in contact with the sciatic nerve after subfascial versus extrafascial lateral popliteal injections. ⋯ Placement of the needle tip beneath the complex fascial sheath of the sciatic nerve resulted in significantly greater perineural local anesthetic volume following a single-injection lateral popliteal approach at the nerve bifurcation and was associated with greater sensory blockade and a characteristic laminar LA spread pattern.
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Reg Anesth Pain Med · Nov 2012
Comparative StudyComparative perioperative outcomes associated with neuraxial versus general anesthesia for simultaneous bilateral total knee arthroplasty.
The influence of the type of anesthesia on perioperative outcomes after bilateral total knee arthroplasty (BTKA) remains unknown. Therefore, we examined a large sample of BTKA recipients, hypothesizing that neuraxial anesthesia would favorably impact on outcomes. ⋯ Neuraxial anesthesia for BTKA is associated with significantly lower rates of blood transfusions and, by trend, decreased morbidity. Although by itself the effect may be limited, N might be used within a multimodal approach to reduce complications after BTKA.
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Reg Anesth Pain Med · Nov 2012
In Zucker diabetic fatty rats, subclinical diabetic neuropathy increases in vivo lidocaine block duration but not in vitro neurotoxicity.
Application of local anesthetics may lead to nerve damage. Increasing evidence suggests that risk of neurotoxicity is higher in patients with diabetic peripheral neuropathy. In addition, block duration may be prolonged in neuropathy. We sought to investigate neurotoxicity in vitro and block duration in vivo in a genetic animal model of diabetes mellitus type 2. ⋯ In vitro, local anesthetic neurotoxicity was more pronounced on neurons from diabetic animals, but the survival difference was small. In vivo, subclinical neuropathy leads to substantial prolongation of block duration. We conclude that early diabetic neuropathy increases block duration, whereas the observed increase in toxicity was small.
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Reg Anesth Pain Med · Nov 2012
Effect of acute versus continuous glycemic control on duration of local anesthetic sciatic nerve block in diabetic rats.
The duration of nerve block is longer in streptozotocin (STZ)-induced diabetic rats for all local anesthetics (with and without adjuvants) compared with normal rats. Perioperative glycemic control is currently practiced to reduce adverse events in many at-risk patients, especially in diabetic patients, to prevent neuropathy, poor wound healing, and greater incidence of infection. The aim of this study was to investigate in diabetic rats the importance of glycemic control before peripheral nerve block. ⋯ With continuous glycemic control in diabetic rats, the duration of sensory and motor nerve block was about 40 minutes shorter than that in the untreated diabetic rats and similar to that of normal rats. However, acute glycemic control did not affect nerve block duration, suggesting that this neuropathy cannot be rapidly reversed.
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Reg Anesth Pain Med · Nov 2012
Education in regional anesthesia: caseloads, simulation, journals, and politics: 2011 Carl Koller Lecture.
This special article is an essay version of the European Society of Regional Anaesthesia and Pain Therapy 2011 Carl Koller Award lecture. Historically, evaluations of a trainee's regional anesthesia learning focused on caseload numbers. The deficiency of this unidimensional approach is that case numbers alone say little about the resident's mastery of the nontechnical aspects of regional anesthesiology. ⋯ Journals play an important role in regional anesthesia education for both trainees and mature anesthesiologists. Editorial boards build valuable educational foundations by providing critical analysis of new technologies and sponsoring practice advisories. Subspecialty societies such as European Society of Regional Anaesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine foster regional anesthesia education through their efforts to define curricula, produce guidelines, and promote international collaboration.