Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2008
Identification of the epidural space using pressure measurement with the compuflo injection pump--a pilot study.
While epidural anesthesia (EA) is frequently used, success rate varies and complications associated with incorrect needle placement can occur. Different methods of objective identification of the epidural space (ES) have been suggested, without receiving widespread popularity. This prospective pilot study evaluated continuous pressure measurement during low speed injection with a computerized injection pump to objectively identify the ES. ⋯ This investigation demonstrates that a computerized injection pump can be used to identify the epidural space and can serve as a base for further comparative research to determine whether this technology can increase the success rate of EA or lower the incidence of side effects.
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Reg Anesth Pain Med · Jul 2008
Evaluation of magnetic resonance imaging following neuraxial steroid administration: does epidural injection produce pathologic findings?
Infection or hematoma following epidural anesthesia is a rare but potentially devastating complication unless diagnosed early. In order to diagnose spinal cord involvement, the currently recommended imaging test is magnetic resonance imaging (MRI). Despite this, no previous studies have been performed to define typical MRI findings following uneventful epidural injection. The purpose of this pilot study was to compare magnetic resonance images before and after epidural injection to define the characteristic appearance of MRI following an uneventful epidural steroid injection. ⋯ The results of this pilot study demonstrated that after uneventful epidural injection in otherwise healthy patients, there were no new pathologic findings on MRI scans. Further MRI studies in large populations and in different clinical situations should be performed to confirm these preliminary findings.
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Reg Anesth Pain Med · Jul 2008
Case ReportsCase report: limitation of local anesthetic spread during ultrasound-guided interscalene block. Description of an anatomic variant with clinical correlation.
The use of ultrasound (US) for localization of neural structures allows real-time visualization of anatomy; however, variability in the arrangement of structures has been observed. The impact of these variations on the performance and outcome of regional anesthetic techniques remains unclear. We discuss possible anatomic explanations and correlation with clinical observations. ⋯ This case illustrates the ability of US to identify anatomic variations and their relevance to the performance of regional anesthetic techniques.
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Reg Anesth Pain Med · Jul 2008
Case ReportsLimitations and technical considerations of ultrasound-guided peripheral nerve blocks: edema and subcutaneous air.
Despite advantages of ultrasound-guided peripheral nerve blocks as compared with established techniques, various limitations may exist. We present 2 trauma patients in whom the usefulness of ultrasound techniques was limited by edema and subcutaneous air. ⋯ Ultrasound technique limitations do exist. We present 2 conditions, edema and subcutaneous air, which contributed to ultrasound failure to provide a clear image of the targeted nerves.
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Reg Anesth Pain Med · Jul 2008
Case ReportsSpinal cord injury produced by direct damage during cervical transforaminal epidural injection.
Cervical transforaminal epidural steroid injection (TFESI) has become a common treatment for cervical radiculopathy. We describe a case of spinal cord injury caused by direct injection of iohexol into the cervical spinal cord during cervical TFESI. ⋯ This case report draws attention to this very serious complication of cervical TFESI. It is essential to confirm final needle position using both anteroposterior and lateral fluoroscopy before any injection through the needle.