Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2010
ReviewUltrasound-guided regional anesthesia and patient safety: An evidence-based analysis.
The role of ultrasound-guided regional anesthesia (UGRA) in reducing the frequency of regional anesthetic-related complications is difficult to ascertain from analyzing the limited literature on the topic. This evidence-based review critically evaluates the contributions of UGRA to improved patient safety, particularly as compared with standard nerve localization tools. Randomized controlled trials that compared UGRA with another form of neural localization and case series of more than 500 patients were used to compare safety parameters. ⋯ Statistical proof for meaningful reduction in the frequency of extremely rare complications, such as permanent peripheral nerve injury, is likely unattainable. Although there is evidence for UGRA reducing the occurrence of vascular puncture and the frequency of hemidiaphragmatic paresis, as yet there is at best inconclusive scientific proof that these surrogate outcomes are linked to actual reduction of their associated complications, such as local anesthetic systemic toxicity or predictable diaphragmatic impairment in at-risk individuals. This evidence-based review thus strives to summarize both the power and the limitations of UGRA as a tool for improving patient safety.
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Reg Anesth Pain Med · Mar 2010
Randomized Controlled TrialUltrasound-guided continuous femoral nerve block for analgesia after total knee arthroplasty: catheter perpendicular to the nerve versus catheter parallel to the nerve.
This study tested the hypothesis that, in continuous femoral nerve block (CFNB) under ultrasound guidance, placing a catheter perpendicular to the nerve can shorten the time of catheter insertion while providing a similar quality of analgesia compared with placing a catheter parallel to the nerve. ⋯ In CFNB under ultrasound guidance, using the catheter perpendicular to the nerve technique can shorten the time of catheter insertion while providing a similar quality of analgesia after total knee arthroplasty as compared with the catheter parallel to the nerve technique.
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Reg Anesth Pain Med · Mar 2010
Comparative StudySonographic identification of needle tip by specialists and novices: a blinded comparison of 5 regional block needles in fresh human cadavers.
Needle visibility using ultrasound remains problematic at steep insertion angles. Despite modified techniques, steep approaches are still needed, particularly in the obese, neuraxial anesthesia or pain blocks around the spine. We describe a novel technique for objective assessment of needle-tip identification and present data on a new needle. ⋯ Needle T demonstrated good properties even at steep insertion angles. Tip location was accurate, and observers rated it highly visible. Ability to identify needle-tip position can be objectively assessed.
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Reg Anesth Pain Med · Mar 2010
Pulsed radiofrequency for the treatment of occipital neuralgia: a prospective study with 6 months of follow-up.
Occipital neuralgia is a paroxysmal nonthrobbing, stabbing pain in the area of the greater or lesser occipital nerve caused by irritation of these nerves. Although several therapies have been reported, no criterion standard has emerged. This study reports on the results of a prospective trial with 6 months of follow-up in which pulsed radiofrequency treatment of the greater and/or lesser occipital nerve was used to treat this neuralgia. ⋯ Pulsed radiofrequency treatment of the greater and/or lesser occipital nerve is a promising treatment of occipital neuralgia. This study warrants further placebo-controlled trials.
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Reg Anesth Pain Med · Mar 2010
Safety of high volume lipid emulsion infusion: a first approximation of LD50 in rats.
Lipid infusion reverses systemic local anesthetic toxicity. The acceptable upper limit for lipid administration is unknown and has direct bearing on clinical management. We hypothesize that high volumes of lipid could have undesirable effects and sought to identify the dose required to kill 50% of the animals (LD(50)) of large volume lipid administration. ⋯ The LD(50) of rapid, high volume lipid infusion is an order of magnitude greater than doses typically used for lipid rescue in humans and supports the safety of lipid infusion at currently recommended doses for toxin-induced cardiac arrest. Lung and liver histopathology was observed at the highest infused volumes.