Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Sep 2008
Review Practice GuidelineRegional anesthesia in anesthetized or heavily sedated patients.
The American Society of Regional Anesthesia and Pain Medicine (ASRA) Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine includes an evidence- and expert opinion-based section on performing procedures on anesthetized or heavily sedated patients. This practice advisory is based on existing scientific literature, pathophysiological principles, and expert opinion. ⋯ The advisory panel also considered whether or not the ability to recognize and report symptoms could actually affect the occurrence of nerve injury or local anesthetic systemic toxicity. The advisory contains recommendations pertaining to both adult and pediatric patients.
-
Reg Anesth Pain Med · Sep 2008
Case ReportsLong-axis ultrasound imaging of the nerves and advancement of perineural catheters under direct vision: a preliminary report of four cases.
Ultrasound allows visualization of in plane needle insertion toward a nerve and the perineural spread of local anesthetic (LA) solution. However, advancement and final positioning of perineural catheters is difficult to visualize. We assessed the feasibility of long axis nerve scans for controlling perineural catheter placement. ⋯ This short case series suggests that long axis imaging of the nerve, the needle, and the catheter allows visualization of a catheter's advancement. Using to-and-fro movements, and slight rotation the needle's bevel, the catheter may be maneuvered under the ultrasound beam, which facilitates correct positioning.
-
Reg Anesth Pain Med · Sep 2008
Biography Historical ArticleRegional anesthesia: advancing the practice of medicine; the 2008 Gaston Labat Award lecture.
-
Reg Anesth Pain Med · Sep 2008
Multicenter Study Comparative StudyComplications associated with eye blocks and peripheral nerve blocks: an american society of anesthesiologists closed claims analysis.
Concern for block-related injury and liability has dissuaded many anesthesiologists from using regional anesthesia for eye and extremity surgery, despite many studies demonstrating the benefits of regional over general anesthesia. To determine injury patterns and liability associated with eye and peripheral nerve blocks, we re-examined the American Society of Anesthesiologists Closed Claims Database as part of the American Society of Regional Anesthesia and Pain Medicine's Practice Advisory on Neurologic Complications of Regional Anesthesia and Pain Medicine. ⋯ Performance of eye blocks by anesthesiologists significantly alters their liability profile, primarily related to permanent eye damage from block needle trauma. Though most peripheral nerve block claims are associated with temporary injuries, local anesthetic toxicity is a major cause of death or brain damage in these claims.
-
Reg Anesth Pain Med · Sep 2008
ReviewPathophysiology of peripheral nerve injury during regional anesthesia.
Despite attention to technical details in performance of regional anesthetics, damage to nerves continues to be a concern. Understanding of pathophysiological mechanisms may aid in decreasing the incidence and severity of such injuries. ⋯ The relative importance of these pathogenic factors in cases of nerve injury after regional anesthesia is not resolved.