Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · May 2013
Development and evaluation of a score to predict difficult epidural placement during labor.
Difficult epidural placement (DEP) during labor may be distressing for the patient and may increase the risk of dural puncture. A score predicting DEP based on the combination of individual risk factors could identify high-risk patients. This study aimed to identify risk factors for DEP and build a prediction score. ⋯ This study confirms risk factors for DEP and proposes a score to predict DEP. The score identifies high-risk patients who may benefit from an intervention to decrease DEP. This hypothesis should be evaluated in an impact study.
-
Reg Anesth Pain Med · May 2013
Case ReportsTrialing of intrathecal baclofen therapy for refractory stiff-person syndrome.
Stiff-person syndrome (SPS) is a rare disorder of the central nervous system characterized by stiffness and muscle spasms that may be progressive in nature. When oral medication is inadequate to control muscle spasticity, intrathecal baclofen may be used. We report a patient with severe SPS and glutamate decarboxylase negative [GAD(-)] (note: GAD(-) indicates the patient has no antibodies to GAD), refractory to oral standard therapies. The patient was effectively trialed with an intrathecal catheter and subsequently treated with chronic intrathecal baclofen, which provided significant relief of spasticity symptoms. ⋯ Refractory SPS is difficult to treat and has few therapeutic options. We report a GAD(-) patient with SPS and resulting debilitating spasticity that was refractory to oral medications who underwent successful continuous intrathecal catheter trial of baclofen over 4 days and subsequently went on to implantation of intrathecal pump. The literature reports only 5 cases of GAD(-) SPS patients treated with intrathecal baclofen therapy, and these resulted in poor long-term success. Our patient completed a 4-day trial of intrathecal baclofen titrated to effect before pump implantation. We advocate continuous intrathecal trialing, as opposed to single-injection technique, to possibly better determine the effective therapeutic dose and ensure posttrialing successful therapy.
-
Reg Anesth Pain Med · May 2013
Randomized Controlled Trial Comparative StudyA randomized comparison between ultrasound- and fluoroscopy-guided third occipital nerve block.
Third occipital nerve block (TONB) is commonly used in the diagnosis and treatment of upper neck pain and cervicogenic headaches. Although fluoroscopy is the current imaging standard for TONB, ultrasound (US) guidance offers a promising, radiation-free alternative. In this randomized, observer-blinded trial, we compared the 2 imaging modalities. Our research hypothesis was that US guidance would result in a shorter performance time. ⋯ Fluoroscopy and US guidance provide similar success rates for TONB. However, ultrasonography is associated with improved efficiency (decreased performance time, fewer needle passes).
-
Reg Anesth Pain Med · May 2013
Randomized Controlled TrialA randomized comparison between 3 combinations of volume and concentration of lidocaine for ultrasound-guided infraclavicular block.
This prospective, randomized, observer-blinded study compared 3 combinations of volume and concentration using the same total dose of lidocaine for ultrasound-guided infraclavicular block. ⋯ Using an identical dose (525 mg) of adrenalized lidocaine for ultrasound-guided infraclavicular block, we found no differences in onset time among 3 commonly used concentrations (1%, 1.5%, and 2%). Further studies are required to determine the optimal combination of volume and concentration of lidocaine for other ultrasound-guided approaches to the brachial plexus.
-
Reg Anesth Pain Med · May 2013
The myth of the equiangular triangle for identification of sacral hiatus in children disproved by ultrasonography.
A triangle formed by the sacral hiatus and posterior superior iliac spines (PSISs) has been known as equiangular and has been proposed as a way to help identify the sacral hiatus for a caudal block. In children, however, no feasibility study of this triangle has been performed. We compared the expected sacral hiatus obtained from the equiangular triangle method and the real sacral hiatus confirmed by ultrasound. ⋯ In children, using the equiangular triangle to identify the sacral hiatus may be inappropriate because the actual triangle formed by the sacral hiatus and PSISs is not equiangular.