Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2015
Randomized Controlled Trial Comparative StudyHemidiaphragmatic Paralysis Following Ultrasound-Guided Supraclavicular Versus Infraclavicular Brachial Plexus Blockade: A Randomized Clinical Trial.
The comparative incidences of hemidiaphragmatic paralysis associated with contemporary ultrasound-guided supraclavicular versus infraclavicular blockade have not received extensive study. We tested the hypothesis that the infraclavicular approach results in a lower incidence of hemidiaphragmatic paralysis compared with supraclavicular blockade when a standard local anesthetic volume and concentration are used. ⋯ Ultrasound-guided supraclavicular blockade with 30 mL of 0.5% ropivacaine produced complete hemidiaphragmatic paralysis in approximately one-third of patients. The infraclavicular approach greatly reduced this risk but did not eliminate it. These data may aid in the selection of the approach to brachial plexus blockade, particularly in ambulatory patients and/or those with respiratory comorbidities.
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Reg Anesth Pain Med · Mar 2015
Fluoroscopic Evaluation of Contrast Distribution Within the Adductor Canal.
This case series assesses the in vivo spread of contrast within the adductor canal in subjects who recently underwent a total knee arthroplasty. A previous analysis of profound leg weakness with a continuous adductor canal revealed contrast spread from the adductor canal to the femoral triangle with as little as 2 mL of volume. ⋯ This study reveals that in vivo continuous infusions within the adductor canal spread in both a cephalad and caudad direction in limited fashion. Although a previous report described proximal spread of injectate to the level of the common femoral nerve, this event is infrequent.
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Reg Anesth Pain Med · Mar 2015
Randomized Controlled Trial Comparative StudyIntravenous Dexamethasone and Perineural Dexamethasone Similarly Prolong the Duration of Analgesia After Supraclavicular Brachial Plexus Block: A Randomized, Triple-Arm, Double-Blind, Placebo-Controlled Trial.
Dexamethasone 8 mg has equal effect in prolonging single-shot supraclavicular block whether given perineurial or intravenously.
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