Articles: nerve-block.
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Multicenter Study
Incidence and root cause analysis of wrong-site pain management procedures: a multicenter study.
Medical errors exact an inordinate toll on healthcare costs. One of the most publicized and analyzed type of medical error is wrong-site surgery. Yet, despite the burgeoning number of procedures performed, no literature exists on wrong-site pain management injections. The purpose of this study was to estimate the relative incidence and determine the causes of wrong-site pain management procedures. ⋯ Wrong-site nerve blocks occur more frequently in pain management centers than has previously been acknowledged. Adaptation of the universal protocol to nerve blocks and strict adherence to widely accepted guidelines may prevent wrong-site interventional pain procedures.
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Reg Anesth Pain Med · Nov 2009
Randomized Controlled Trial Multicenter Study Comparative StudyHemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block.
Supraclavicular brachial plexus block is associated with 50% to 67% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether ultrasound-guided compared with nerve stimulation supraclavicular brachial plexus block using 0.75% ropivacaine results in a lower incidence of hemidiaphragmatic paresis. ⋯ Ultrasound-guided supraclavicular brachial plexus block, using 20 mL of 0.75% ropivacaine with the described technique, is not associated with hemidiaphragmatic paresis.
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled Trial Multicenter Study Comparative StudyEffect on neurostimulation of injectates used for perineural space expansion before placement of a stimulating catheter: normal saline versus dextrose 5% in water.
We clinically assessed the electrophysiologic effect of dextrose 5% in water (D5W) and of normal saline (NS) used for expansion of the perineural space before placing a stimulating catheter. We questioned if higher current was required with NS but not with D5W, as has been observed experimentally. ⋯ The current needed to electrostimulate the femoral or sciatic nerve was higher after injection of NS than after D5W.
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Reg Anesth Pain Med · Jul 2009
Multicenter StudyVarious possible positions of conventional catheters around the femoral nerve revealed by neurostimulation.
In continuous femoral nerve blocks, the various perineural positions of the tip of a conventional catheter and their clinical implication are not completely known.We used stimulating catheters to explore the relationship of catheter tip to nerve. ⋯ The effectiveness of a continuous femoral block depends on neurostimulation characteristics, which likely correspond to various possible catheter tip positions. Conventional catheters provide no information on this issue. These results suggest that better VAS scores are attainable by placing catheters with neurostimulation guidance.
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Comment Letter Multicenter Study
Survey of combined regional blocks and general anaesthesia.