Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2012
ReviewEpidural technique for postoperative pain: gold standard no more?
Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in postoperative pain management. However, newer, evidence-based outcome data show that the benefits of epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic epidural analgesia with local anaesthetic drugs only. ⋯ The number of indications for the use of epidural analgesia seems to be decreasing for a variety of reasons. The decision about whether to continue using epidural techniques should be guided by regular institutional audits and careful risk-benefit assessment rather than by tradition. For routine postoperative analgesia, epidural analgesia may no longer be considered the gold standard.
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Reg Anesth Pain Med · May 2012
Randomized Controlled TrialEffect of local anesthetic volume (15 vs 40 mL) on the duration of ultrasound-guided single shot axillary brachial plexus block: a prospective randomized, observer-blinded trial.
One of the advantages of ultrasound-guided peripheral nerve block is that visualization of local anesthetic spread allows for a reduction in dose. However, little is known about the effect of dose reduction on sensory and motor block duration. The purpose of the present study was to compare the duration of sensory and motor axillary brachial plexus block (ABPB) with 15 or 40 mL mepivacaine 1.5%. ⋯ In ABPB with mepivacaine 1.5%, reducing the dose from 40 mL to 15 mL (62.5%) shortens the overall duration of sensory and motor block by approximately 17% to 19%, reduces sensory and motor block duration of individual nerves by 18% to 40%, and decreases the time to first request of postoperative analgesia by approximately 30%.
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Reg Anesth Pain Med · May 2012
Primary payer status is associated with the use of nerve block placement for ambulatory orthopedic surgery.
Although more than 30 million patients in the United States undergo ambulatory surgery each year, it remains unclear what percentage of these patients receive a perioperative nerve block. We reviewed data from the 2006 National Survey of Ambulatory Surgery to determine the demographic, socioeconomic, geographic, and clinical factors associated with the likelihood of nerve block placement for ambulatory orthopedic surgery. The primary outcome of interest was the association between primary method of payment and likelihood of nerve block placement. In addition, we examined the association between type of surgical procedures, patient demographics, and hospital characteristics with the likelihood of receiving a nerve block. ⋯ For patients receiving ambulatory orthopedic surgery in the United States, our results suggest that geographic and socioeconomic factors are associated with different likelihoods of perioperative peripheral nerve block placement.
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Reg Anesth Pain Med · May 2012
Comparative StudyThe effects of fluid injection on lesion size during bipolar radiofrequency treatment.
The effect of preinjected fluid on bipolar radiofrequency (RF) lesion characteristics has not been investigated with conventional pain medicine equipment. The purpose of the present study was to determine the effect of preinjected fluid composition on lesion parameters. ⋯ Fluid composition influences success, alters lesion size, and could be an appropriate consideration when selecting treatment parameters for bipolar RF. The enhanced lesion size and improved odds of producing a successful lesion with increasing NaCl concentration suggest a method to enlarge lesion size in a controlled manner.
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Reg Anesth Pain Med · May 2012
The creation of an objective assessment tool for ultrasound-guided regional anesthesia using the Delphi method.
The assessment of technical skills in ultrasound-guided regional anesthesia is currently subjective and relies largely on observations of the trainer. The objective of this study was to develop a checklist to assess training progress and to detect training gaps in ultrasound-guided regional anesthesia using the Delphi method. ⋯ Using the Delphi method, a checklist and GRS were developed. These tools can serve as an objective means of assessing progress in ultrasound technical skills acquisition.