Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2016
High Opening Injection Pressure Is Associated With Needle-Nerve and Needle-Fascia Contact During Femoral Nerve Block.
High opening injection pressures (OIPs) have been shown to predict sustained needle tip contact with the roots of the brachial plexus. Such roots have a uniquely high ratio of fascicular versus connective tissue. It is unknown if this relationship is preserved during multifascicular nerve blockade. We hypothesized that OIP can predict needle-nerve contact during femoral nerve block, as well as detect needle contact with the fascia iliaca. ⋯ Opening injection pressure greater than 15 psi was associated with a block needle tip position slightly indenting the epineurium of the femoral nerve (90%) and the fascia iliaca (100%). Needle tip positions not indenting these structures were associated with OIP of less than 15 psi (100%).
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Reg Anesth Pain Med · Jan 2016
Greater Cephalad Extent of Thoracic Epidural Sensory Anesthesia After Lidocaine and Epinephrine Test Dose Correlates With Analgesic Consumption and Pain Burden After Uterine Fibroid Artery Embolization.
Ischemic pain after uterine fibroid artery embolization (UFAE) is often severe. We evaluated the sensory anesthesia extent from thoracic epidural catheter test injection of lidocaine 75 mg with epinephrine 25 μg as a predictor of analgesia effectiveness after UFAE. ⋯ Sensory anesthesia spread above the T6 dermatome 30 minutes after a test dose of 1.5% lidocaine was an independent predictor of the analgesic consumption after UFAE. Pain burden and oral opioid consumption were also increased in subjects who demonstrated a high sensory spread after the test dose.
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Reg Anesth Pain Med · Jan 2016
Trends in the Use of Regional Anesthesia: Neuraxial and Peripheral Nerve Blocks.
A growing body of evidence indicates that the use of regional anesthesia offers advantages over general anesthesia, not only in terms of reducing complications but also regarding resource utilization and patient satisfaction. Because of the paucity of data on the nationwide adoption of regional anesthesia techniques, we aimed to elucidate trends in the use of neuraxial anesthesia (NA) and peripheral nerve blocks (PNBs) in orthopedic surgeries. ⋯ Our findings provide important insight into the dynamics of the adoption of regional anesthetic techniques. Whereas PNB utilization is significantly increasing, overall, NA and PNBs are performed in the minority of cases. With accumulating evidence in favor of regional anesthesia, promoting the use of NA and a further increase in PNB utilization could have far-reaching medical and economic implications.
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Reg Anesth Pain Med · Jan 2016
Epidural Steroid Injections for Radiculopathy and/or Back Pain in Children and Adolescents: A Retrospective Cohort Study With a Prospective Follow-Up.
Epidural steroid injections (ESIs) are commonly performed for adults with spinal pain and/or radiculopathy. Previous pediatric ESI case series were not identified by literature review. The primary aim of this study was to examine the safety and provisional outcomes of pediatric ESIs. ⋯ Children and adolescents can receive ESIs under conscious sedation with good safety. Further prospective studies may better define the role for these injections in the comprehensive management of pediatric spinal pain disorders.