Regional anesthesia and pain medicine
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We aimed to describe the ultrasound appearance of the radial nerve in the lateral aspect of the distal upper arm. This procedure was done to identify potential novel sites for ultrasound-guided radial-nerve block. ⋯ Points B and C may represent convenient, novel sites for ultrasound-guided radial-nerve block. The nerve is clearly visualized and has not yet divided into superficial and deep branches. Point C may be the optimal site for radial-nerve block because of the smaller risk of vessel puncture. Our observations also demonstrate the ability of ultrasound to identify nerves at sites not clearly defined by surface anatomic landmarks.
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Reg Anesth Pain Med · May 2007
Ultrasound-guided and CT-navigation-assisted periradicular and facet joint injections in the lumbar and cervical spine: a new teaching tool to recognize the sonoanatomic pattern.
The aim of this study is to provide a teaching tool to facilitate the acquirement of periradicular and facet-joint infiltration techniques in the cervical and lumbar spine. ⋯ This teaching tool provides immediate CT-verification of sonographically identified structures and helps in the identification of bony landmarks, which are necessary for facet-joint and periradicular injections.
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Reg Anesth Pain Med · May 2007
Biography Historical ArticleExploring origins: was John Bonica's model of modern-day pain management influenced by John Lundy's earlier work?
Contemporary pain medicine is a multimodality and multidisciplinary field. Many of the current ideas and styles of practice that influence the specialty today can be traced back to John Bonica, M. D., and his model of pain management introduced more than 50 years ago. ⋯ While in the army during World War II, Bonica worked closely with his Chief of Surgery, Joel Deuterman, M. D., a physician who had trained at the Mayo Clinic, where he was exposed to Lundy and his techniques. Deuterman may have influenced Bonica's ideas concerning the treatment of chronic painful conditions.
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Reg Anesth Pain Med · May 2007
Altered blood flow in terminal vessels after local application of ropivacaine and prilocaine.
Ropivacaine is primarily a local anesthetic, but it also acts as a vasoactive agent. Case reports have described a critical reduction in blood flow when higher concentrations of ropivacaine were used for peripheral-nerve blocks. One hypothesis is that local application of ropivacaine in tissues supplied by end arteries reduces tissue blood flow because of arterial vasoconstriction. ⋯ The application of ropivacaine directly to a rat's tail artery diminished blood flow and lowered regional skin temperature. These effects were dose related. The use of ropivacaine at higher concentrations can, therefore, not be recommended if tissues supplied by end arteries might be affected.