Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2012
Ultrasound-guided ankle block for forefoot surgery: the contribution of the saphenous nerve.
Ankle blocks typically include the block of 5 nerves, the 4 branches that trace their origin back to the sciatic nerve plus the saphenous nerve (SaN). The sensory area of the SaN in the foot is variable. Based on our clinical experience, we decided to study the sensory distribution of the SaN in the foot and determine whether the block of this nerve is necessary as a component of an ultrasound-guided ankle block for bunion surgery. ⋯ Ultrasound-guided ankle block is a highly effective technique for bunion surgery. The sensory territory of the SaN in the foot seems to extend only to the midfoot. According to our sample, 97% of the patients undergoing bunion surgery under an ankle block would not benefit from having a SaN block.
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Reg Anesth Pain Med · Sep 2012
Randomized Controlled TrialPerineural clonidine does not prolong levobupivacaine 0.5% after sciatic nerve block using the Labat approach in foot and ankle surgery.
There is controversy about the effectiveness of perineural clonidine used as an adjuvant to local anesthetics. This study investigated whether the addition of 150 μg clonidine to 0.5% levobupivacaine used for posterior sciatic nerve block would prolong the duration of analgesia. ⋯ Addition of 150 μg clonidine to 20 mL of levobupivacaine 0.5% in posterior gluteal (Labat) sciatic nerve block did not prolong the duration of analgesia but had a slight effect on systolic arterial pressure.
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Reg Anesth Pain Med · Sep 2012
Randomized Controlled Trial Comparative StudyA prospective, randomized comparison between perivascular and perineural ultrasound-guided axillary brachial plexus block.
This prospective, randomized, observer-blinded study compared perivascular (PV) and perineural (PN) ultrasound-guided axillary brachial plexus block (AXB) for upper extremity surgery. ⋯ Perivascular and PN ultrasound-guided AXBs result in comparable success rates and total anesthesia-related times. Because of fewer needle passes and a shorter performance time, the PV technique provides a simple alternative for ultrasound-guided AXB.
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Reg Anesth Pain Med · Sep 2012
Randomized Controlled TrialRandomized study of the effect of local anesthetic volume and concentration on the duration of peripheral nerve blockade.
Ultrasound guidance reduces the required local anesthetic volume for successful peripheral nerve block, but it is unclear whether this influences block duration. We investigated the ropivacaine volume and concentration effect on interscalene block duration. ⋯ Block duration is influenced by both local anesthetic volume and concentration, a finding of increasing relevance with the current trend to lower volumes for ultrasound-guided regional anesthesia.
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Reg Anesth Pain Med · Sep 2012
ReviewThe definition of block "success" in the contemporary literature: are we speaking the same language?
A successful nerve block is the common goal that shapes modern regional anesthesia practice and research, yet the meaning of block "success" can be open to interpretation. For this Special Article, we reviewed all applicable randomized controlled trials published over the last decade to determine the most commonly used definitions of block success. We also sought to uncover which relevant indicators of block success are routinely reported in the contemporary literature. ⋯ Surgeon- and hospital administrator-related indicators were not collected in any trial. We found that the definition of block success is highly variable in the contemporary regional anesthesia literature. Our findings underscore the clear and present need for a comprehensive definition of block success, whereas future research should endeavor to capture the indicators of block success that are important to all key perioperative stakeholders.