Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2008
New model for learning ultrasound-guided needle to target localization.
The acquisition of technical skills for the novice learner presents challenges for students and teachers alike. With the introduction of ultrasound techniques in regional anesthesia, there has been interest from residents, fellows, and staff to acquire the skills necessary to incorporate this technology into their everyday practice. However, as both ultrasound machines and commercial target models are inherently costly, there are often issues of accessibility that may affect the opportunity to learn the desired skills. ⋯ This report presents an inexpensive, variable complexity model for learning ultrasound-guided needle-to-target localization.
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Reg Anesth Pain Med · Jul 2008
Ultrasound-guided midthigh sciatic nerve block-a clinical and anatomical study.
Ultrasound-guided sciatic nerve block is a relatively new regional anesthesia technique with few descriptions in the literature. The objective of this study was to assess the ease with which the sciatic nerve could be imaged in the midthigh region using ultrasound and to describe the anatomy surrounding the sciatic nerve at this location. ⋯ Ultrasonic identification of the sciatic nerve at the midthigh level can be achieved; however, in this study, 37.5% of patients required nerve stimulation to confirm its sonographic appearance. Target nerve localization and the subsequent performance of the sciatic nerve block may be enhanced by recognition of surrounding muscular and fascial structures which were also identified using ultrasound.
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Reg Anesth Pain Med · Jul 2008
Stereospecific interaction of bupivacaine enantiomers with lipid membranes.
S(-)-Bupivacaine has the pharmacotoxicological advantage over its antipode and racemate. The interaction with lipid membranes was compared between S(-)-, R(+)- and racemic bupivacaine. ⋯ Bupivacaine stereostructure-specifically interacts with membranes containing cholesterol, which is consistent with the clinical features of S(-)-bupivacaine. Membrane cholesterol appears to increase the chirality of lipid bilayers and enable them to interact with S(-)-, racemic and R(+)-bupivacaine differently.
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Reg Anesth Pain Med · Jul 2008
Intraneural catheterization of the sciatic nerve in humans: a pilot study.
Imaging studies in humans have shown that intraneural injection of local anesthetic may be relatively frequent. The incidence of intraneural catheterization is unknown. We speculated that early neural blockade after the injection of a small dose of local anesthetic might be a common finding produced by unintended intraneural catheterization. We investigated the clinical effect of a small dose of local anesthetic injected through a stimulating sciatic catheter, and also the placement of the tip of the catheters by computed tomography (CT) scan. ⋯ Intraneural catheterization of the sciatic nerve may be a frequent finding and was not followed by nerve injury under the conditions of our small pilot study.