Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2015
The Ultrasound-Guided Retroclavicular Block: A Prospective Feasibility Study.
The aim of this feasibility study was to determine the success rate (sensory and surgical) of the novel retroclavicular block and to thoroughly describe the technique. In addition, needle tip and shaft visibility, needling time, procedural discomfort, motor block success rate, patient satisfaction at 48-hour follow-up, and complications were also recorded. ⋯ In this study, the novel retroclavicular block offered a quick, safe, and reliable alternative for distal arm block. Further studies, comparing this approach with the classic infraclavicular block, are required to validate its efficacy, safety, and reliability.
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Reg Anesth Pain Med · Sep 2015
Case ReportsRotational Thromboelastometry-Guided Hemostatic Therapy for Management of Cerebrospinal Fluid Catheter in Patients Undergoing Endovascular Aortic Repair.
Central neuraxial techniques are typically avoided in patients with underlying coagulopathy or abnormal coagulation tests. Vertebral canal hematoma is a rare but devastating complication of those procedures. Although the sensitivity and specificity of standard laboratory tests in predicting this event are rather poor or unknown, these tests are commonly used to allow or advise against the insertion of an epidural or spinal catheter. Furthermore, the role of viscoelastic point-of-care tests, which are widely used to monitor coagulation in the perioperative setting, is unexplored. ⋯ Thromboelastometry proved useful to guide hemostatic therapy before subarachnoid catheter placement and extraction in a patient with severe coagulopathy when standard coagulation tests were of less benefit.
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Reg Anesth Pain Med · Sep 2015
Does Spinal Block Through Tattooed Skin Cause Histological Changes in Nervous Tissue and Meninges?: An Experimental Model in Rabbits.
Although there is no documented evidence that tattoo pigments can cause neurological complications, the implications of performing neuraxial anesthesia through tattooed skin are unknown. In this study, we aimed to assess whether spinal puncture performed through tattooed skin of rabbits determines changes over the spinal cord and meninges. In addition, we sought to evaluate the presence of ink fragments entrapped in spinal needles. ⋯ On the basis of the present results, intrathecal injection of saline through a needle inserted through tattooed skin is capable of producing histological changes over the meninges of rabbits. Ink fragments were entrapped inside the spinal needles, despite the presence of a stylet.
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Reg Anesth Pain Med · Sep 2015
Case ReportsPercutaneous Rupture of a Symptomatic Facet Joint Synovial Cyst Using 2-Needle Distention.
This case report calls attention to an alternative approach for management of a symptomatic facet joint synovial cyst. We describe a patient with a symptomatic facet joint synovial cyst who failed an attempted percutaneous rupture using a single-needle technique. This patient was subsequently successfully managed with percutaneous rupture using a 2-needle technique. ⋯ Percutaneous rupture of a symptomatic facet joint synovial cyst using a single-needle technique has been validated as an efficacious form of management. In a select group of patients who fail single-needle percutaneous rupture, a 2-needle approach for percutaneous facet cyst rupture may be considered as an option for management.