Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2007
Ultrasound-guided obturator nerve block: a preliminary report of a case series.
Obturator-nerve block improves analgesia for knee surgery. Traditional techniques rely on surface landmarks, which can be variable and result in excessive performance times and multiple needle passes. The objective of this study was to evaluate a novel ultrasound-guided technique for localizing the obturator nerve. ⋯ These preliminary data suggest that ultrasound-guided obturator-nerve identification and block are technically easy and highly successful.
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Reg Anesth Pain Med · May 2007
Clinical TrialHigh-resolution ultrasound-guided high interscalene plexus block for carotid endarterectomy.
High-resolution ultrasound imaging (HRUI) allows real-time visualization of peripheral nerves, needle insertion, and the spread of local-anesthetic (LA) solution. We evaluated the feasibility of performing a high interscalene brachial-plexus block for carotid endarterectomy by means of HRUI, thereby limiting the amount of LA to the dose required to sufficiently surround the relevant nerve structures. ⋯ High-resolution ultrasonic imaging allows clear depiction of the target tissues and facilitates accurate needle placement during high interscalene brachial-plexus blocks. This technique may minimize the risk of direct puncture-related complications, as well as accidental intravascular injection of LA. The observation of LA spread in all patients, even in small increments of less than 1 mL might enhance safety by limiting the injected LA to the actual demand. Well-placed LA spread could potentially avoid central nervous toxicity caused by intravascular injection or resorption of inadequately high dosages, in particular in nerve blocks of the highly vascularized neck region.
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Reg Anesth Pain Med · May 2007
Comparative StudyComparison of different injectate volumes for stellate ganglion block: an anatomic and radiologic study.
Volumes from 5 to 20 mL of local anesthetic are used for stellate ganglion block. The variation of practice gave us the impetus to investigate the distribution of 3 different volumes of solution. We documented the regions reached by each volume to assess the possibility to reduce the injectate to 5 mL. ⋯ The use of 5 mL results in an almost ideal vertical distribution in most of the cadavers, whereas high volumes--20 mL more so than 10 mL--are at risk of spreading extensively in both the vertical direction and also uncontrollably to other regions of the neck.
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We aimed to describe the ultrasound appearance of the radial nerve in the lateral aspect of the distal upper arm. This procedure was done to identify potential novel sites for ultrasound-guided radial-nerve block. ⋯ Points B and C may represent convenient, novel sites for ultrasound-guided radial-nerve block. The nerve is clearly visualized and has not yet divided into superficial and deep branches. Point C may be the optimal site for radial-nerve block because of the smaller risk of vessel puncture. Our observations also demonstrate the ability of ultrasound to identify nerves at sites not clearly defined by surface anatomic landmarks.
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Reg Anesth Pain Med · May 2007
Biography Historical ArticleExploring origins: was John Bonica's model of modern-day pain management influenced by John Lundy's earlier work?
Contemporary pain medicine is a multimodality and multidisciplinary field. Many of the current ideas and styles of practice that influence the specialty today can be traced back to John Bonica, M. D., and his model of pain management introduced more than 50 years ago. ⋯ While in the army during World War II, Bonica worked closely with his Chief of Surgery, Joel Deuterman, M. D., a physician who had trained at the Mayo Clinic, where he was exposed to Lundy and his techniques. Deuterman may have influenced Bonica's ideas concerning the treatment of chronic painful conditions.