Regional anesthesia and pain medicine
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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
Anatomic Basis for Brachial Plexus Block at the Costoclavicular Space: A Cadaver Anatomic Study.
The costoclavicular space (CCS), which is located deep and posterior to the midpoint of the clavicle, may be a better site for infraclavicular brachial plexus block than the traditional lateral paracoracoid site. However, currently, there is paucity of data on the anatomy of the brachial plexus at the CCS. We undertook this cadaver anatomic study to define the anatomy of the cords of the brachial plexus at the CCS and thereby establish the anatomic basis for ultrasound-guided infraclavicular brachial plexus block at this proximal site. ⋯ The cords of the brachial plexus are clustered together lateral to the axillary artery, and share a consistent relation relative to one another and to the axillary artery, at the CCS.
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Reg Anesth Pain Med · May 2016
Are Cure Rates for Breast Cancer Improved by Local and Regional Anesthesia?
Recent preclinical basic science studies suggest that patient tumor immunity is altered by general anesthesia (GA), potentially worsening cancer outcomes. A single retrospective review concluded that breast cancer patients receiving paravertebral block and GA had better cancer outcomes compared with patients receiving GA alone. This study has not been validated. We hypothesized that local or regional anesthesia (LRA) would be associated with better cancer outcomes compared with GA. ⋯ Breast cancer OS, DFS, and LRR were not affected by type of anesthesia in our institution. This result differs from that of the only prior published clinical report on this topic and does not provide clinical corroboration of the basic science studies that suggest oncologic benefits to LRA.
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Reg Anesth Pain Med · May 2016
The Nerves of the Adductor Canal and the Innervation of the Knee: An Anatomic Study.
Adductor canal block contributes to analgesia after total knee arthroplasty. However, controversy exists regarding the target nerves and the ideal site of local anesthetic administration. The aim of this cadaveric study was to identify the trajectory of all nerves that course in the adductor canal from their origin to their termination and describe their relative contributions to the innervation of the knee joint. ⋯ The results suggest that both the SN and NVM contribute to the innervation of the anteromedial knee joint and are therefore important targets of adductor canal block. Given the site of exit of both nerves in the distal third of the adductor canal, the midportion of the adductor canal is suggested as an optimal site of local anesthetic administration to block both target nerves while minimizing the possibility of proximal spread to the femoral triangle.