Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2014
Cadaveric Study of Sacroiliac Joint Innervation: Implications for Diagnostic Blocks and Radiofrequency Ablation.
Optimization of clinical outcomes of lateral branch radiofrequency ablation or blocks for sacroiliac joint (SIJ) pain requires precise nerve localization; however, there is a lack of comprehensive morphological studies. The objectives of this cadaveric study were to document SIJ innervation relative to bony landmarks in 3 dimensions and to identify reference points visible under ultrasound and fluoroscopy for optimal needle placement. ⋯ Based on the innervation pattern and using bony landmarks identifiable under ultrasound and fluoroscopy, 2 radiofrequency ablation techniques were proposed. Further research is required to determine the accuracy and reliability of needle placement and to evaluate clinical outcomes.
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Reg Anesth Pain Med · Nov 2014
Mechanisms Underlying Midazolam-Induced Peripheral Nerve Block and Neurotoxicity.
The benzodiazepine midazolam has been reported to facilitate the actions of spinally administrated local anesthetics. Interestingly, despite the lack of convincing evidence for the presence of γ-aminobutyric acid type A (GABAA) receptors along peripheral nerve axons, midazolam also has been shown to have analgesic efficacy when applied alone to peripheral nerves.These observations suggest midazolam-induced nerve block is due to another site of action. Furthermore, because of evidence indicating that midazolam has equal potency at the benzodiazepine site on the GABAA receptor and the 18-kd translocator protein (TSPO), it is possible that at least the nerve-blocking actions of midazolam are mediated by this alternative site of action. ⋯ Our results indicate that processes underlying midazolam-induced nerve block and neurotoxicity are separable, and suggest that selective activation of TSPO may facilitate modality-selective nerve block while minimizing the potential for neurotoxicity.
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Reg Anesth Pain Med · Nov 2014
Comparative StudyA Valid and Reliable Assessment Tool for Remote Simulation-Based Ultrasound-Guided Regional Anesthesia.
The purpose of this study was to establish construct and concurrent validity and interrater reliability of an assessment tool for ultrasound-guided regional anesthesia (UGRA) performance on a high-fidelity simulation model. ⋯ This is the first study to demonstrate the validity and reliability of a Global Rating Scale assessment tool for use in UGRA simulation training. Although the checklist may require further refinement, the Global Rating Scale can be used for remote and on-site assessment of UGRA skills.
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Reg Anesth Pain Med · Nov 2014
Randomized Controlled TrialThe Effect of Gowning on Labor Epidural Catheter Colonization Rate: A Randomized Controlled Trial.
The need to gown for labor epidural catheter insertion is controversial. The American Society of Regional Anesthesia and Pain Medicine has identified a lack of randomized controlled trials investigating this issue. The purpose of this study was to examine the effect of gowning on colonization rates following epidural catheter insertion for labor analgesia. ⋯ The use of gowns in the current study did not affect catheter colonization rate. Overall, there was a relatively high incidence of catheter-tip colonization in both groups, which underscores the need for strict aseptic technique.