Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2010
Randomized Controlled TrialDoes "opening the perineural space" before stimulating catheter placement for continuous nerve block add value in clinical practice?
A study using unblinded block performance and subjective outcome measurements suggested that "opening the space" surrounding the femoral nerve with 10 mL dextrose 5% in water (D5W) before catheter placement facilitated placement and improved the quality of the nerve block. We conducted a double-blind, prospectively randomized study to evaluate this suggestion by adding objective measurements to the original subjective measurements. ⋯ The findings of this study do not support the concept that opening the space surrounding the femoral nerve with D5W before femoral catheter placement adds value to perineural catheter placement.
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Reg Anesth Pain Med · May 2010
Randomized Controlled TrialUltrasound-guided popliteal block distal to sciatic nerve bifurcation shortens onset time: a prospective randomized double-blind study.
Popliteal sciatic nerve block (SNB) in combination with saphenous nerve block provides anesthesia and analgesia for foot and ankle surgeries. Landmark-based and image-guided techniques, to date, aim at blocking the sciatic nerve proximal to its bifurcation. Sciatic nerve block is usually associated with a long onset time (30-60 mins). We hypothesized that SNB distal to its bifurcation (blocking its 2 main branches tibial and common peroneal nerves separately) is associated with a shorter onset time than blockade proximal to its bifurcation. ⋯ Our data suggest that popliteal SNB distal to the bifurcation has a shorter onset time than SNB proximal to its bifurcation, and therefore, it may be a good option when a fast onset for a surgical block is required.
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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
Randomized Controlled TrialUltrasound does not improve the success rate of a deep peroneal nerve block at the ankle.
The deep peroneal nerve is 1 of 5 nerves anesthetized when performing an ankle block. Multiple techniques of blocking the deep peroneal nerve have been described, but little evidence exists to delineate the efficacy of any one technique. We hypothesized that ultrasound would increase both the success rate and the quality of a deep peroneal nerve block at the ankle. ⋯ The use of ultrasound seems to improve the onset of deep peroneal nerve block at the ankle but does not improve the overall quality of the block.
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Reg Anesth Pain Med · Mar 2010
Randomized Controlled TrialWound spread of radiolabeled saline with multi- versus few-hole catheters.
Continuous wound infusion of local anesthetics is effective in postoperative pain management and may be useful in major joint arthroplasty, but the optimal technique for postoperative administration of local anesthetics in the wound awaits trials evaluating the optimal type of catheter (single-, few-, or multiholed catheters). ⋯ Wound spread of a bolus injection through 15-cm multiholed catheters versus triple-orifice epidural catheters is similar with subfascial catheter placement in total hip arthroplasty. Procedure-specific trials are required to evaluate the analgesic efficacy of postoperative administration of local anesthetic in the wound with different types of catheter before general recommendations can be made.