Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2009
Randomized Controlled TrialUltrasound improves the success rate of a sural nerve block at the ankle.
: During ankle block performance, anesthetizing the sural nerve is important for generating complete anesthesia of the lateral aspect of the foot. We hypothesized that an ultrasound-guided perivascular approach, utilizing the lesser saphenous vein as a reference, would prove more successful than a conventional approach based on surface landmarks. ⋯ : Ultrasound guidance using the lesser saphenous vein as a reference point results in a more complete and longer lasting sural nerve block than does a traditional approach using surface landmarks.
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Reg Anesth Pain Med · Jan 2009
Comparative StudyElectrocardiographic and hemodynamic effects of intravenous infusion of bupivacaine, ropivacaine, levobupivacaine, and lidocaine in anesthetized ewes.
Neural blockade techniques are associated with a risk of acute cardiac toxicity after accidental intravenous (IV) injection of local anesthetics. The aim of this study was to compare electrocardiographic (ECG) and hemodynamic (HEM) effects induced by IV infusion of local anesthetics in an anesthetized ewe model. ⋯ In our anesthetized ewe model, high dose IV infusion of BUPI induced the most marked changes in RR, PR, QRS, QT, QTc intervals, DeltaSAP, and DeltadP/dt. ROPI altered ECG variables less than BUPI but more than S-BUPI. LIDO was associated with the smallest changes.
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Reg Anesth Pain Med · Jan 2009
Case ReportsInterscalene perineural catheter placement using an ultrasound-guided posterior approach.
The posterior approach to the brachial plexus--or cervical paravertebral block--has advantages over the anterolateral interscalene approach, but concerns regarding "blind" needle placement near the neuraxis have limited the acceptance of this useful technique. We present a technique to place an interscalene perineural catheter that potentially decreases neuraxial involvement with the use of ultrasound guidance. ⋯ Continuous interscalene block using an ultrasound-guided posterior approach is an alternative technique that retains the benefits of posterior catheter insertion, but potentially reduces the risk of complications that may result from blind needle insertion.
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Reg Anesth Pain Med · Jan 2009
Case ReportsNeuraxial anesthesia and intraoperative bilevel positive airway pressure in a patient with severe chronic obstructive pulmonary disease and obstructive sleep apnea undergoing elective sigmoid resection.
This case report describes the anesthetic management of a patient with severe chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) who underwent elective sigmoid resection under combined spinal-epidural anesthesia and bilevel positive airway pressure (BiPAP). ⋯ Combined spinal-epidural anesthesia was successfully used in a patient with COPD and OSA undergoing sigmoid resection. Perioperative administration of BiPAP, excellent pain control by continuous epidural infusion of local anesthetic, and the avoidance of endotracheal intubation may have contributed to this patient's uncomplicated postoperative course.
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Reg Anesth Pain Med · Jan 2009
Ultrasound-guided posterior approach for the placement of a continuous interscalene catheter.
The posterior approach to performing a continuous brachial plexus block at the level of the nerve roots has been described using traditional superficial landmarks. We describe an ultrasound-guided approach for the placement of a continuous interscalene brachial plexus catheter at the level of the nerve roots using a posterior approach. In addition, we provide the clinical characteristics of the first 16 catheters placed at our institution utilizing this approach. ⋯ Results suggest the use of ultrasound for placing a continuous interscalene nerve catheter via the posterior approach is a viable technique that offers an alternative to the more conventional non-image-guided superficial landmark techniques.