Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2016
Randomized Controlled Trial Comparative StudyEvaluation of a New Needle Guidance System for Ultrasound: Results of a Prospective, Randomized, Blinded Study.
Accurate needle control during ultrasound (US)-guided nerve blocks may be an elusive goal for the anesthesiologist. Despite modifications to increase echogenicity, needle visibility still requires precise alignment within the transducer beam. In this study, we evaluated a magnetically guided ultrasound (MGU) system that produces a real-time, graphic display of the needle position and trajectory that is independent of the US beam. ⋯ In a tissue model, the MGU system improved control of needle trajectory and needle tip position for both inexperienced and experienced subjects.
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Reg Anesth Pain Med · May 2016
Case ReportsLumbar Epidural Hematoma Following Interlaminar Fluoroscopically Guided Epidural Steroid Injection.
Spinal epidural steroid injections are generally considered a safe, effective treatment for radicular pain in a variety of spinal conditions. Complications secondary to these injections, although rare, can result in devastating neurologic symptoms. Patients with preexisting moderate-to-severe spinal stenosis and recent use of chronic anticoagulation pose a challenging dilemma when making treatment decisions, as a history of both can increase the risk of complications. ⋯ This case report describes the potential risk factors present in this patient. Presence of spinal stenosis and the interlaminar approach seem to be significant risk factors in this case. Presence of an intrinsic coagulopathy was not determined.
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Reg Anesth Pain Med · May 2016
Comparative StudyLocal Drug Infiltration Analgesia During Knee Surgery to Reduce Postoperative Pain in Rats.
There is increasing interest in local infiltration analgesia (LIA) to reduce postoperative pain with knee surgery. Despite widespread use of LIA, wide variations in drug combinations, infiltration techniques, and the concomitant use of systemic analgesics have made it difficult to determine the optimal drug combination for LIA.Using a previously validated animal knee surgery model, we aimed to determine the optimal combination of medications to reduce postoperative pain, and the best anatomical location and timing for local drug injection during surgery. ⋯ Our animal study suggests that clinical trials with LIA combinations of local anesthetic, nonsteroidal anti-inflammatory drug, and corticosteroid might be useful for reducing postoperative pain after knee surgery, with the nonsteroidal anti-inflammatory drug having the greatest effect.Perioperative physicians should consider delivering LIA earlier during the procedure as opposed to solely at the time of wound closure.