Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Mar 2010
ReviewUltrasound-guided interventional procedures in pain management: Evidence-based medicine.
Recently, there has been a growing interest in the application of ultrasonography in pain medicine because ultrasound provides direct visualization of various soft tissues and real-time needle advancement and avoids exposing the health care provider and the patient to the risks of radiation. The machine itself is more affordable and transferrable than a fluoroscopy, computed tomography scan, or magnetic resonance imaging machine. These factors make ultrasonography an attractive adjunct to other imaging modalities in interventional pain management especially when those modalities are not available or feasible. The present article reviews the existing evidence that evaluates the role of ultrasonography in spine interventional procedures in pain management.
-
Severe, systemic local anesthetic toxicity is arguably the most feared complication of regional anesthesia. A combination of old and new therapies is recommended to reduce the morbidity and mortality of symptomatic local anesthetic overdose. Prevention remains the criterion standard for improving patient safety during regional anesthesia. ⋯ Lipid infusion should be considered early, and the treating physician should be familiar with the method. We also recommend avoiding vasopressin and using epinephrine only in small doses. Vigilance, preparedness, and quick action will improve outcomes of this dreaded complication.
-
To summarize the existing evidence behind the role of ultrasonography in neuraxial anesthesia techniques. ⋯ Neuraxial ultrasonography has been recently introduced to regional anesthesia practice. The limited data available to date suggest that it is a useful adjunct to physical examination, allowing for a highly precise identification of regional landmarks and a precise estimation of epidural space depth, thus facilitating epidural catheter insertion. Further research is needed to conclusively establish its impact on procedure success and safety profile, particularly in the adult nonobstetric population.
-
Reg Anesth Pain Med · Mar 2010
ReviewModels and mechanisms of local anesthetic cardiac toxicity: a review.
Cardiovascular collapse, even death, may occur after intoxication with bupivacaine or related amide local anesthetic agents. The problem has been studied in myriad laboratories for more than 20 years. Nevertheless, there is consensus neither regarding which animal model best mimics this clinical catastrophe nor as to which ion channel, enzyme, or other local anesthetic binding site represents the point of initiation for the process. This review aimed to define the various credible mechanisms that have been proposed to explain cardiovascular collapse and death after administration of local anesthetics, particularly after bupivacaine and related agents.
-
Reg Anesth Pain Med · Sep 2009
ReviewUltrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures: part I: nonaxial structures.
Application of ultrasound in pain medicine is a rapidly growing medical field in interventional pain management. Ultrasound provides direct visualization of various soft tissues and real-time needle advancement and avoids exposing both the health care provider and the patient to the risks of radiation. The machine itself is more affordable than a fluoroscope, computed tomography scan, or magnetic resonance imaging machine. In the present review, we discuss the challenges and limitations of ultrasound-guided procedures for pain management, anatomy, and sonoanatomy of selected pain management procedures and the literature on those selected procedures.