Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Comparative StudyEchogenic technology can improve needle visibility during ultrasound-guided regional anesthesia.
Needle tip visualization is fundamental to the safety and efficacy of ultrasound-guided regional anesthesia (UGRA). It can be extremely challenging especially at steep insertion angles. We assessed whether an echogenic needle improved tip visibility during UGRA by anesthesiologists performing their normal in-plane technique. ⋯ Tip visibility with the Sonoplex was independent of insertion angle over the range studied (0-57 degrees, P=0.95). This finding occurred when nonexpert anesthesiologists performed their standard UGRA technique. A needle that is visible for a greater percentage of time has potential safety and efficacy implications.
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Reg Anesth Pain Med · Jan 2011
Randomized Controlled Trial Comparative StudyA randomized comparison of infraclavicular and supraclavicular continuous peripheral nerve blocks for postoperative analgesia.
Although the efficacy of single-injection supraclavicular nerve blocks is well established, no controlled study of continuous supraclavicular blocks is available, and their relative risks and benefits remain unknown. In contrast, the analgesia provided by continuous infraclavicular nerve blocks has been validated in randomized controlled trials. We therefore compared supraclavicular with infraclavicular perineural local anesthetic infusion following distal upper-extremity surgery. ⋯ A local anesthetic infusion via an infraclavicular perineural catheter provides superior analgesia compared with a supraclavicular perineural catheter.
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Reg Anesth Pain Med · Jan 2011
Randomized Controlled Trial Comparative StudyDecreasing the local anesthetic volume from 20 to 10 mL for ultrasound-guided interscalene block at the cricoid level does not reduce the incidence of hemidiaphragmatic paresis.
This prospective, randomized, double blind study was designed to determine whether reduction in volume from 20 to 10 mL of ropivacaine 0.5% for ultrasound-guided interscalene block might decrease the incidence of diaphragmatic paresis and preserve pulmonary function. ⋯ Decreasing the volume for interscalene block from 20 to 10 mL did not reduce the incidence of hemidiaphragmatic paresis or impairment in pulmonary function, which persisted at discharge from recovery room. No significant differences in quality or duration of analgesia were observed.
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Reg Anesth Pain Med · Jan 2011
Randomized Controlled Trial Comparative StudyLidocaine pretreatment with tourniquet versus lidocaine-propofol admixture for attenuating propofol injection pain: a randomized controlled trial.
Findings from studies investigating optimal techniques for attenuating propofol-related injection pain are inconsistent. In previous studies, lidocaine pretreatment using a tourniquet has been reported to be superior, inferior, or equivalent to a lidocaine-propofol admixture for reducing pain. This discordance could represent either no meaningful difference in the treatments or underlying methodological differences in the previous studies. We hypothesized that tourniquet-controlled pretreatment with lidocaine would be superior to lidocaine-propofol admixture for reducing propofol injection pain. ⋯ Tourniquet-controlled pretreatment with lidocaine is statistically superior to admixing lidocaine with propofol for reducing propofol injection pain intensity, but the clinical importance of this small effect is questionable. However, pretreatment more effectively eliminates injection pain.
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Reg Anesth Pain Med · Nov 2010
Randomized Controlled Trial Comparative StudyA randomized comparison between ultrasound-guided and landmark-based superficial cervical plexus block.
This prospective, randomized, observer-blinded study compared ultrasound guidance and the conventional landmark-based technique for superficial cervical plexus blockade. ⋯ Ultrasound guidance does not increase the success rate of superficial cervical plexus block compared with a landmark-based technique. Additional confirmatory trials are required.