Regional anesthesia and pain medicine
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Today, there is a growing appreciation of the importance of the obturator nerve in clinical anesthesia. The aim of this study is to describe the ultrasound appearance of the obturator nerve for potential utility in guiding these nerve blocks. ⋯ The obturator nerve and its divisions are the flattest peripheral nerves yet described with ultrasound imaging. Knowledge of the obturator nerve's ultrasound appearance facilitates localization of this nerve for regional block and may increase success of such procedures.
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Reg Anesth Pain Med · Mar 2007
Randomized Controlled TrialPharmacokinetics of levobupivacaine, fentanyl, and clonidine after administration in thoracic paravertebral analgesia.
There is little knowledge of the pharmacokinetics of local anesthetics and adjunctive analgesics after paravertebral blockade. We evaluated the pharmacokinetics of low-dose levobupivacaine, fentanyl, and clonidine after paravertebral analgesia for breast surgery. ⋯ After paravertebral bolus and infusion administration, Cpmax levobupivacaine was within the safe range. Cpmax fentanyl and clonidine were less than the effective levels after IV administration, suggesting that their analgesic effect may be partly attributed to a peripheral mechanism of action.
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Reg Anesth Pain Med · Mar 2007
Spread of injectate associated with radial or median nerve-type motor response during infraclavicular brachial-plexus block: an ultrasound evaluation.
We have compared ultrasound characteristics of spread during infraclavicular brachial-plexus blocks by use of electrically evoked radial-nerve- or median-nerve-type distal motor responses to guide the injection of 30 mL of 1.5% mepivacaine. ⋯ We have demonstrated that as compared with median-nerve-type motor response, injection performed after a radial-nerve-type motor response promoted reproducible and remarkable ultrasound spread characteristics associated with complete sensory block of the 3 cords at 30 minutes.
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Reg Anesth Pain Med · Mar 2007
Prepuncture ultrasound-measured distance: an accurate reflection of epidural depth in infants and small children.
Epidural cannulation is technically difficult in children who have small anatomic structures. Ultrasound information regarding the distance of skin-to-ligament flavum may be useful, leading to an increase in success rate without dural puncture. This study was performed to assess whether ultrasound-measured, skin-to-ligament flavum distance would reflect the needle depth during epidural puncture in infants and children. ⋯ Ultrasound, particularly in the longitudinal median view, provides accurate information on the distance of skin-to-ligament flavum in infants and children. With reference to the measured distance, epidural puncture can be performed with minimal risk of dural puncture (upper limit of 95% CI = 1.67%).
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Reg Anesth Pain Med · Mar 2007
Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia.
Ultrasound-guided regional anesthesia is a rapidly growing field. There exists little information regarding the competencies involved with such a practice. The objective of this exploratory study was to characterize the behavior of novices as they undertook the challenges of learning a new technique. In addition to assessing for both committed errors and accuracy, we aimed to identify previously unrecognized quality-compromising behaviors that could help structure effective training interventions. ⋯ Based on the analysis of the committed errors and the identification of quality-compromising behaviors, we are able to recommend important targets for learning in future training and simulation programs.