Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2015
Case ReportsWorsening of Neurologic Symptoms After Spinal Anesthesia in Two Patients With Spinal Stenosis.
Spinal stenosis has been proposed as a previously unrecognized risk factor for neurologic complications after neuraxial techniques. ⋯ We conclude that, until the relative contribution of patient and surgical (eg, positioning, retractors, hypotension) factors is known, the decision to perform neuraxial blockade in patients with severe symptoms of neuroclaudication or recently progressive symptomatic spinal stenosis should be made cautiously. Avoidance of spinal anesthesia is suggested for any procedure with prolonged lordotic positioning or any position that might cause a compromise of the spinal canal because subarachnoid block may contribute to any deterioration suffered by the patient.
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Reg Anesth Pain Med · Sep 2015
Case ReportsA Novel Modified Retrocrural Approach for Celiac Plexus Block: The Single-Needle Retroaortic Technique.
For patients with pain from upper abdominal malignancies, celiac plexus neurolysis can provide an effective means of pain control. However, there are instances when traditionally described percutaneous approaches may not be technically feasible. ⋯ We present 4 cases of patients with pain from upper abdominal malignancies in whom we performed celiac plexus neurolysis using a novel single-needle retroaortic approach. All 4 patients had significant pain relief and no significant adverse effects from the retroaortic approach.
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Reg Anesth Pain Med · Sep 2015
Randomized Controlled Trial Comparative StudyA Comparison of 2 Ultrasound-Guided Approaches to the Saphenous Nerve Block: Adductor Canal Versus Distal Transsartorial: A Prospective, Randomized, Blinded, Noninferiority Trial.
Saphenous nerve blocks can be technically challenging. Recently described ultrasound techniques have improved the success rate of saphenous nerve blocks, but randomized controlled trials comparing these ultrasound-guided techniques are lacking. We compared 2 common ultrasound-guided approaches for saphenous nerve block: saphenous nerve block at the adductor canal (ACSNB) versus block by the distal transsartorial (DTSNB) approach. ⋯ Ultrasound-guided block of the saphenous nerve at the adductor canal is not only noninferior but also superior to block at the distal transsartorial level in terms of success rate, with additional advantages of faster block onset time and better nerve visibility under ultrasound.
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Reg Anesth Pain Med · Sep 2015
ReviewNeurologic Evaluation and Management of Perioperative Nerve Injury.
Neurologic injury after regional anesthesia or pain medicine procedures is rare. Postprocedural neurologic deficits may create high levels of anxiety for the patient and practitioner, although most deficits are limited in severity and can be expected to fully resolve with time. Postoperative anesthesia-related neuraxial and peripheral nerve injuries are reviewed to define an efficient, structured approach to these complications. Emphasis is placed on acutely stratifying the urgency and scope of diagnostic testing or consultation necessity, initiating appropriate definitive treatments, and defining appropriate out-of-hospital follow-up and symptom management.