Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2015
Randomized Controlled Trial Comparative StudyRandomized Comparison of Extrafascial Versus Subfascial Injection of Local Anesthetic During Ultrasound-Guided Supraclavicular Brachial Plexus Block.
The optimal site for local anesthetic injection during an ultrasound-guided supraclavicular brachial plexus block (BPB) is not known. We tested the hypothesis that local anesthetic injected deep to the "brachial plexus sheath" during supraclavicular BPB would produce faster onset of surgical anesthesia than an injection superficial to the sheath. ⋯ Injection of local anesthetic deep to the brachial plexus sheath at the supraclavicular fossa, under ultrasound-guidance, results in faster onset of surgical anesthesia and prolonged duration of postoperative analgesia than an injection superficial to the sheath.
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Reg Anesth Pain Med · May 2015
Randomized Controlled TrialImpact of pregabalin on the occurrence of postthoracotomy pain syndrome: a randomized trial.
Postthoracotomy pain syndrome (PTPS) is a frequent cause of chronic postoperative pain. Pregabalin might reduce the incidence of chronic postoperative pain. The goal of this study was to evaluate the impact of perioperative pregabalin on the occurrence of PTPS, defined as any surgical site pain 3 months after surgery. ⋯ Pregabalin did not reduce the incidence of PTPS in this study. Future research on PTPS should focus on the impact of regional analgesia on central sensitization.
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Reg Anesth Pain Med · Mar 2015
Randomized Controlled Trial Comparative StudyIntravenous Dexamethasone and Perineural Dexamethasone Similarly Prolong the Duration of Analgesia After Supraclavicular Brachial Plexus Block: A Randomized, Triple-Arm, Double-Blind, Placebo-Controlled Trial.
Dexamethasone 8 mg has equal effect in prolonging single-shot supraclavicular block whether given perineurial or intravenously.
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Reg Anesth Pain Med · Mar 2015
Randomized Controlled TrialNovice Performance of Ultrasound-Guided Needling Skills: Effect of a Needle Guidance System.
Ultrasound-guided needle placement is a widely used technical skill that can be challenging to learn. The SonixGPS is a novel ultrasound needle-tracking system that has the potential to improve performance over traditional ultrasound systems. The objective of our study was to determine if the use of the SonixGPS ultrasound system improves performance of novice practitioners in ultrasound-guided needle placement compared with conventional ultrasound in the out-of-plane approach on a simulation model. ⋯ Use of the SonixGPS ultrasound needle guidance system improves the performance of technical needling skills of novice trainees in an ex vivo model. The place of this technology in the wider education of ultrasound-guided regional anesthesia remains to be established.
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Reg Anesth Pain Med · Mar 2015
Randomized Controlled Trial Comparative StudyHemidiaphragmatic Paralysis Following Ultrasound-Guided Supraclavicular Versus Infraclavicular Brachial Plexus Blockade: A Randomized Clinical Trial.
The comparative incidences of hemidiaphragmatic paralysis associated with contemporary ultrasound-guided supraclavicular versus infraclavicular blockade have not received extensive study. We tested the hypothesis that the infraclavicular approach results in a lower incidence of hemidiaphragmatic paralysis compared with supraclavicular blockade when a standard local anesthetic volume and concentration are used. ⋯ Ultrasound-guided supraclavicular blockade with 30 mL of 0.5% ropivacaine produced complete hemidiaphragmatic paralysis in approximately one-third of patients. The infraclavicular approach greatly reduced this risk but did not eliminate it. These data may aid in the selection of the approach to brachial plexus blockade, particularly in ambulatory patients and/or those with respiratory comorbidities.