Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2012
ReviewRegional anesthesia and analgesia in critically ill patients: a systematic review.
Regional anesthesia has become invaluable for the treatment of pain during and after a wide range of surgical procedures. However, its benefits in the nonsurgical setting have been less well studied. ⋯ Patients in the critical care unit present special challenges to the regional anesthesiologist, including coagulopathies, infections, immunocompromised states, sedation- and ventilation-associated problems, and factors potentially increasing the risk for systemic toxicity. This review is intended to evaluate the role of regional anesthesia in critically ill patients, to discuss potential benefits, and to provide a summary of the published evidence on the subject.
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Reg Anesth Pain Med · Sep 2012
Randomized Controlled TrialPersistent median artery (palmar type) and median nerve block in the forearm: observational study of prevalence.
We sought to define the crude prevalence rate of the persistent median artery (PMA) (palmar type). Although there is no reported case in the anesthetic literature, a few sporadic case reports and series reported in anatomical and orthopedic journals describe an incidence of between 1.5% and 27.1%. ⋯ Anatomical variations of the blood supply to the forearm and hand can be identified with available high-frequency ultrasound equipment. Arterial variants immediately adjacent to the median nerve may occur in approximately 1 in 5 limbs. Practitioners should actively seek their presence or absence.
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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 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.