Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2013
Randomized Controlled Trial Comparative StudyUltrasound-guided Sciatic Nerve Block in Overweight and Obese Patients: A Randomized Comparison of Performance Time Between the Infragluteal and Subgluteal Space Techniques.
Despite ultrasound (US) guidance, sciatic nerve block (SNB) remains among the least performed peripheral blocks. By targeting the tissue plane between the gluteus maximus and quadratus femoris muscles, the US-guided subgluteal space technique may facilitate the performance of US-guided SNB. We aimed to evaluate whether the subgluteal space technique shortens SNB performance time in overweight and obese patients compared with the conventional infragluteal technique. ⋯ The subgluteal space technique may be performed 50% faster, with no detectable differences in block success and analgesic efficacy, compared with the infragluteal technique for US-guided SNB in overweight and obese patients receiving multimodal analgesia. Injection of local anesthetics along tissue planes may produce similar block characteristics to perineural injection for US-guided SNB.
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The sensory innervation of the clavicle remains controversial. The supraclavicular, subclavian, and long thoracic/suprascapular nerves, alone or together, may be responsible for pain transmission after clavicular fracture and surgery. Peripheral nerve blocks used to anesthetize the clavicle include superficial cervical plexus blocks, interscalene blocks, and combined superficial cervical plexus-interscalene blocks. Future (randomized) trials are required to determine which constitutes the best option for emergency department (fracture) and operating room (surgical fixation) settings.
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Reg Anesth Pain Med · Nov 2013
Comparative StudyA Self-Paired Comparison of Perioperative Outcomes Before and After Implementation of a Clinical Pathway in Patients Undergoing Total Knee Arthroplasty.
Clinical pathways commonly modify multiple variables and deviate from long-established clinical practices. Therefore, it is difficult to perform prospective, randomized clinical trials comparing "standard care" to the "new clinical pathway." The goal of this investigation was to examine the impact of clinical pathways implementation on perioperative outcomes and institutional costs in patients undergoing total knee arthroplasty (TKA). ⋯ Our findings demonstrated that the use of a standardized clinical pathway reduced hospital LOS, improved clinical outcomes and patient satisfaction while reducing costs for identical surgical procedures.