Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2010
Historical ArticleLocal anesthetic systemic toxicity: a historical perspective.
The most feared complication associated with the administration of local anesthetics is the profound and potentially lethal effect that these agents can have on cardiac conduction and function. This review traces the evolution of local anesthetic systemic toxicity beginning with the early deaths associated with the introduction of cocaine into clinical practice. The development of bupivacaine is discussed, with particular emphasis on the delayed recognition and acceptance of its inherent cardiotoxicity. Finally, the origins of lipid resuscitation are reviewed with respect to their theoretical foundation, as well as the confluence of events and experimental investigations that delivered this therapy into clinical practice.
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Reg Anesth Pain Med · Mar 2010
ReviewThe ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: Executive summary.
The American Society of Regional Anesthesia and Pain Medicine charged an expert panel to examine the evidence basis for ultrasound guidance as a nerve localization tool in the clinical practices of regional anesthesia and interventional pain medicine. ⋯ Ultrasound guidance improves block characteristics (particularly performance time and surrogate measures of success) that are often block specific and that may impart an efficiency advantage depending on individual practitioner circumstances. Evidence for UGRA impacting patient safety is currently limited to the demonstration of improvements in the frequency of surrogate events for serious complications.