Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2013
Outcomes of shoulder surgery in the sitting position with interscalene nerve block: a single-center series.
Several case reports have raised serious concerns about the safety of shoulder surgery in the beach-chair position, related to global cerebral hypoperfusion. We summarize our experiences with 15,014 cases of shoulder arthroscopy over an 11-year period. Our primary aim was to evaluate the incidence of intraoperative or immediate postoperative neurologic events and secondarily to relate other perioperative complications. ⋯ This retrospective study suggests that intraoperative or immediate postoperative stroke is rare when surgery is conducted in beach-chair position in conjunction with regional anesthesia, propofol sedation, and spontaneous respiration via natural airway.
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Reg Anesth Pain Med · Jan 2013
The utility of ultrasound imaging in predicting ease of performance of spinal anesthesia in an orthopedic patient population.
Ultrasonography of the spine improves technical performance of spinal anesthesia, but what is unclear is whether it can predict difficulty. We tested the hypothesis that a good ultrasound view at a given intervertebral level is associated with absence of technical difficulty. ⋯ Ultrasound can be useful in predicting the absence of technical difficulty in performing dural puncture and thus in selecting the optimal intervertebral level for spinal anesthesia.
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Reg Anesth Pain Med · Jan 2013
Systematic ultrasound identification of the dorsal scapular and long thoracic nerves during interscalene block.
The use of ultrasound for in-plane interscalene block shifts needle insertion to a more posterior approach through the middle scalene muscle, when compared with classic nerve stimulator techniques. Branches from the brachial plexus, including the dorsal scapular and long thoracic nerves, are often anatomically located within the middle scalene muscle. The aim of this study was to use ultrasound to identify and characterize the frequency and position of the dorsal scapular and long thoracic nerves located in the middle scalene muscle. ⋯ This descriptive study revealed that the dorsal scapular and long thoracic nerves routinely could be identified with ultrasound.