Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2013
Randomized Controlled TrialProphylactic ondansetron does not prevent shivering or decrease shivering severity during cesarean delivery under combined spinal epidural anesthesia: a randomized trial.
Prophylactic ondansetron does not prevent shivering during cesarean section under regional block.
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Reg Anesth Pain Med · Jan 2013
Outcomes of shoulder surgery in the sitting position with interscalene nerve block: a single-center series.
Several case reports have raised serious concerns about the safety of shoulder surgery in the beach-chair position, related to global cerebral hypoperfusion. We summarize our experiences with 15,014 cases of shoulder arthroscopy over an 11-year period. Our primary aim was to evaluate the incidence of intraoperative or immediate postoperative neurologic events and secondarily to relate other perioperative complications. ⋯ This retrospective study suggests that intraoperative or immediate postoperative stroke is rare when surgery is conducted in beach-chair position in conjunction with regional anesthesia, propofol sedation, and spontaneous respiration via natural airway.
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Reg Anesth Pain Med · Jan 2013
Case ReportsRespiratory impact of analgesic strategies for shoulder surgery.
Shoulder surgery is associated with significant postoperative pain in many patients. The use of an interscalene nerve block offers good analgesia but is associated with a high incidence of an ipsilateral phrenic nerve block. ⋯ Possible strategies are (1) using very low volumes of local anesthetics, (2) targeting the brachial plexus at a lower level in the neck, (3) applying a suprascapular nerve block, and (4) applying the combination of a suprascapular and an axillary nerve block. Using systemic analgesics is a less favorable strategy because this may result in less potent analgesia and may cause more adverse effects, including respiratory depression and nausea.
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Reg Anesth Pain Med · Jan 2013
Randomized Controlled TrialValue of an electronic tutorial for image interpretation in ultrasound-guided regional anesthesia.
Use of ultrasound-guided regional anesthesia (UGRA) requires considerable training. An embedded electronic tutorial as an element of an ultrasound machine may help to identify sonoanatomy for novices. Therefore, we investigated whether an electronic tutorial could improve accuracy or speed of performance in identifying anatomical structures. ⋯ An electronic tutorial can help novices in UGRA identify anatomical structures. A significant increase in correct identifications was gained at the expense of significantly longer time required for this process. Increased time required may partly be related to unfamiliarity with the tutorial.
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Reg Anesth Pain Med · Jan 2013
Minimum effective volume of lidocaine for double-injection ultrasound-guided axillary block.
The aim of this study was to determine the minimum effective volume of lidocaine 1.5% with epinephrine 5 μg/mL in 90% of patients (MEV90) for double-injection ultrasound-guided axillary block (AXB). ⋯ For double-injection ultrasound-guided AXB, the MEV90 of lidocaine 1.5% with epinephrine 5 μg/mL is 5.5 and 23.5 mL for the musculocutaneous nerve and perivascular injection, respectively. Further dose-finding studies are required for other concentrations of lidocaine, other local anesthetic agents, and other techniques for ultrasound-guided AXB.