Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2016
ReviewEvidence Basis for Ultrasound-Guided Block Characteristics Onset, Quality, and Duration.
This systematic review summarizes existing evidence for superior onset, quality, and duration of block for ultrasound guidance versus other techniques for nerve localization. MEDLINE was systematically searched from 1966 to June 2013 for randomized controlled trials (RCTs) comparing ultrasound guidance to another technique for peripheral nerve blocks. Twenty-three RCTs were identified for upper-extremity peripheral nerve blocks and 17 for lower extremity. ⋯ One RCT reported that ultrasound was inferior for quality and duration for ankle block. There is level 1b evidence to make a grade A recommendation that ultrasound guidance provides a modest improvement in block onset and quality of peripheral nerve blocks, especially for lower extremity. Ultrasound is rarely inferior to other techniques.
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Reg Anesth Pain Med · Mar 2016
ReviewEvidence Basis for Ultrasound Guidance for Lower-Extremity Peripheral Nerve Block: Update 2016.
This article reviews and summarizes randomized controlled studies that have investigated ultrasound guidance (USG) for lower-extremity peripheral nerve blocks in comparison with other peripheral nerve localization techniques and those that compared different ultrasound-guided techniques investigating optimal perineural local anesthetic distribution patterns. Thirty-four studies met the inclusion criteria (minimum Jadad score 3), and 10 additional studies directly compared USG with peripheral nerve stimulation, and 5 additional studies directly compared USG with landmark-based field blocks. ⋯ Ultrasound was never inferior to peripheral nerve stimulation. The research focus has evolved during the last 5 years into investigating optimal ultrasound-guided techniques.
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Reg Anesth Pain Med · Mar 2016
ReviewThe Requisites of Needle-to-Nerve Proximity for Ultrasound-Guided Regional Anesthesia: A Scoping Review of the Evidence.
This scoping review examines the literature to determine whether the position of the needle tip relative to the target nerve is accurately and reliably detected during ultrasound (US)-guided regional anesthesia. The requisites for successful and safe needle tip positioning relative to the target nerve include accurate and reliable needle presentation by the machine, needle interpretation by the operator, nerve presentation by the machine, and nerve interpretation by the operator. ⋯ The acoustic resolution of modern portable US machines limits the extent to which nerve microanatomy can be reliably presented. Finally, our interpretation of the sonographic end points for local anesthetic injection that best balance success and safety for US-guided regional anesthesia continues to evolve.
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Reg Anesth Pain Med · Mar 2016
Clinical TrialQuadratus Lumborum Block: Analgesic Effects and Chronological Ropivacaine Concentrations After Laparoscopic Surgery.
The quadratus lumborum block (QLB) is an abdominal truncal block, similar to transversus abdominis plane block (TAPB). However, the characteristics of QLB with regard to its duration and safety are not well known. The primary aim of this study was to determine the block duration and the cutaneous sensory block area. Our secondary analysis included assessment of the chronological change in arterial local anesthetic concentrations after QLB. ⋯ Quadratus lumborum block resulted in a widespread and long-lasting analgesic effect after laparoscopic ovarian surgery and resulted in lower peak arterial ropivacaine concentrations as compared with those of lateral TAPB after 150 mg ropivacaine injection.