Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2013
Case ReportsAberrant Intrathecal Pump Refill: Ultrasound-guided Aspiration of a Substantial Quantity of Subcutaneous Hydromorphone.
Intrathecal drug delivery systems are an effective and increasingly common pain treatment modality for certain patient populations. Pumps are surgically inserted in a subcutaneous abdominal pocket and refilled with highly concentrated medication at regular intervals. ⋯ We describe the injection of hydromorphone into the pump's surrounding subcutaneous pocket, subsequent opioid overdose, and the novel application of ultrasound to visualize and aspirate the subcutaneous drug. Ultrasonography can be used as an effective modality for rapid diagnosis and treatment of an accidental pocket fill.
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Reg Anesth Pain Med · Nov 2013
Randomized Controlled Trial Comparative StudyUltrasound-guided Sciatic Nerve Block in Overweight and Obese Patients: A Randomized Comparison of Performance Time Between the Infragluteal and Subgluteal Space Techniques.
Despite ultrasound (US) guidance, sciatic nerve block (SNB) remains among the least performed peripheral blocks. By targeting the tissue plane between the gluteus maximus and quadratus femoris muscles, the US-guided subgluteal space technique may facilitate the performance of US-guided SNB. We aimed to evaluate whether the subgluteal space technique shortens SNB performance time in overweight and obese patients compared with the conventional infragluteal technique. ⋯ The subgluteal space technique may be performed 50% faster, with no detectable differences in block success and analgesic efficacy, compared with the infragluteal technique for US-guided SNB in overweight and obese patients receiving multimodal analgesia. Injection of local anesthetics along tissue planes may produce similar block characteristics to perineural injection for US-guided SNB.
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Reg Anesth Pain Med · Nov 2013
Comparative StudyA Self-Paired Comparison of Perioperative Outcomes Before and After Implementation of a Clinical Pathway in Patients Undergoing Total Knee Arthroplasty.
Clinical pathways commonly modify multiple variables and deviate from long-established clinical practices. Therefore, it is difficult to perform prospective, randomized clinical trials comparing "standard care" to the "new clinical pathway." The goal of this investigation was to examine the impact of clinical pathways implementation on perioperative outcomes and institutional costs in patients undergoing total knee arthroplasty (TKA). ⋯ Our findings demonstrated that the use of a standardized clinical pathway reduced hospital LOS, improved clinical outcomes and patient satisfaction while reducing costs for identical surgical procedures.