Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Mar 2016
ReviewUpdate on Ultrasound for Truncal Blocks: A Review of the Evidence.
We summarized the evidence for ultrasound (US) guidance for truncal blocks in 2010 by performing a systematic literature review and rating the strength of evidence for each block using a system developed by the United States Agency for Health Care Policy and Research. Since then, numerous studies of US guidance for truncal blocks have been published. ⋯ To provide updated recommendations, we performed another systematic search of the literature to identify studies pertaining to US guidance for the following blocks: paravertebral, intercostal, transversus abdominis plane, rectus sheath, ilioinguinal/iliohypogastric, as well as the Pecs, quadratus lumborum, and transversalis fascia blocks. We rated the methodologic quality of each of the identified studies and then graded the strength of evidence supporting the use of US for each block based on the number and quality of available studies for that block.
-
Reg Anesth Pain Med · Mar 2016
ReviewUpdate on Ultrasound for Truncal Blocks: A Review of the Evidence.
We summarized the evidence for ultrasound (US) guidance for truncal blocks in 2010 by performing a systematic literature review and rating the strength of evidence for each block using a system developed by the United States Agency for Health Care Policy and Research. Since then, numerous studies of US guidance for truncal blocks have been published. ⋯ To provide updated recommendations, we performed another systematic search of the literature to identify studies pertaining to US guidance for the following blocks: paravertebral, intercostal, transversus abdominis plane, rectus sheath, ilioinguinal/iliohypogastric, as well as the Pecs, quadratus lumborum, and transversalis fascia blocks. We rated the methodologic quality of each of the identified studies and then graded the strength of evidence supporting the use of US for each block based on the number and quality of available studies for that block.
-
Reg Anesth Pain Med · Mar 2016
ReviewEvidence for the Use of Ultrasound Imaging in Pediatric Regional Anesthesia: A Systematic Review.
An earlier review to evaluate the quality and outcomes of studies assessing ultrasound imaging in regional anesthesia for the pediatric population considered articles published from 1994 to 2009 and showed some evidence in support of block-related outcomes (block onset, success, duration) and process-related outcomes (performance time, local anesthetic dose, and spread). At that time, strong evidence in the form of randomized controlled trials and well-designed prospective observational studies was limited, leading to a call for additional research. ⋯ Using the MEDLINE and EMBASE databases, we included in this review studies examining ultrasound imaging for nerve localization in the pediatric population between 2009 and March 2014 (meta-analyses, systematic reviews, randomized controlled trials, controlled studies without randomization, observational studies, comparative studies, and case series involving at least 10 patients). In the current review, we identified 24 and 13 articles evaluating peripheral nerve blocks and neuraxial anesthesia, respectively.
-
Reg Anesth Pain Med · Mar 2016
ReviewEvidence for the Use of Ultrasound Imaging in Pediatric Regional Anesthesia: A Systematic Review.
An earlier review to evaluate the quality and outcomes of studies assessing ultrasound imaging in regional anesthesia for the pediatric population considered articles published from 1994 to 2009 and showed some evidence in support of block-related outcomes (block onset, success, duration) and process-related outcomes (performance time, local anesthetic dose, and spread). At that time, strong evidence in the form of randomized controlled trials and well-designed prospective observational studies was limited, leading to a call for additional research. ⋯ Using the MEDLINE and EMBASE databases, we included in this review studies examining ultrasound imaging for nerve localization in the pediatric population between 2009 and March 2014 (meta-analyses, systematic reviews, randomized controlled trials, controlled studies without randomization, observational studies, comparative studies, and case series involving at least 10 patients). In the current review, we identified 24 and 13 articles evaluating peripheral nerve blocks and neuraxial anesthesia, respectively.
-
Reg Anesth Pain Med · Mar 2016
ReviewThe Second American Society of Regional Anesthesia and Pain Medicine Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia: Executive Summary.
In 2009 and again in 2012, the American Society of Regional Anesthesia and Pain Medicine assembled an expert panel to assess the evidence basis for ultrasound guidance as a nerve localization tool for regional anesthesia. ⋯ Scientific evidence from the past 5 years has clarified and strengthened our understanding of ultrasound-guided regional anesthesia as a nerve localization tool. High-level evidence supports ultrasound guidance contributing to superior characteristics with selected blocks, although absolute differences with the comparator technique are often relatively small (especially for upper-extremity blocks). The clinical meaningfulness of these differences is likely of variable importance to individual practitioners. The use of ultrasound significantly reduces the risk of local anesthetic systemic toxicity as well as the incidence and intensity of hemidiaphragmatic paresis, but has no significant effect on the incidence of postoperative neurologic symptoms. WHAT'S NEW IN THIS UPDATE?: This evidence-based assessment of ultrasound-guided regional anesthesia reviews findings from our 2010 publication and focuses on new meta-analyses, randomized controlled trials, and large case series published since 2009. New to this exercise is an in-depth analysis of the accuracy and reliability of ultrasound guidance for identifying needle-to-nerve relationships. This version no longer addresses ultrasound for interventional pain medicine procedures, because the growth of that field demands separate consideration. Since our 2010 publication, new information has either supported or strengthened our original conclusions. There is no evidence that ultrasound is inferior to alternative nerve localization methods.