Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2007
Epidural catheter placement in neonates: sonoanatomy and feasibility of ultrasonographic guidance in term and preterm neonates.
We report the first prospective sonoanatomic study in neonates with the aim to perform ultrasonographic-guided epidural catheter placement in this age group. ⋯ Ultrasound examination of the spinal cord anatomy provides valuable information for epidural catheter placement in neonates. Ultrasonography enables a real-time identification of the tip of the needle within the epidural space and a visualization of the spread of local anesthetic in these patients.
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Reg Anesth Pain Med · Jan 2007
Randomized Controlled Trial Comparative StudySingle-injection brachial plexus anesthesia for arteriovenous fistula surgery of the forearm: a comparison of infraclavicular coracoid and axillary approach.
The surgical site for the creation of an arteriovenous fistula at the lateral aspect of the distal forearm may be faster and more effectively blocked with the infraclavicular coracoid approach than with the axillary approach for brachial plexus block. ⋯ Blockade of the musculocutaneous nerve developed faster with the infraclavicular coracoid approach than with the axillary approach. The infraclavicular coracoid approach may be preferable in patients scheduled for the creation of an arteriovenous fistula at the forearm.
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Reg Anesth Pain Med · Jan 2007
Case Reports Clinical TrialFalls associated with lower-extremity-nerve blocks: a pilot investigation of mechanisms.
Documented falls after lower-extremity-nerve blocks are rare. We believe this paucity of documented falls is the result of underreporting and the lack of serious complications resulting from these falls. In addition, the mechanism(s) for falls after lower-extremity-nerve blocks has not been elucidated. ⋯ Lower-extremity-nerve blocks result in decreased leg stiffness and lateral instability, which may lead to difficulty with pivoting maneuvers.
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Reg Anesth Pain Med · Jan 2007
An assessment tool for brachial plexus regional anesthesia performance: establishing construct validity and reliability.
Technical proficiency in regional anesthesia is often determined subjectively through in-training evaluations. Objective assessment tools improve these evaluations by providing criteria for measurement. However, any evaluation instrument needs to be valid and reliable before it is adopted into a curriculum. The purpose of this study is to determine the validity and reliability of a devised assessment of residents performing an interscalene brachial plexus block (ISB). ⋯ Both assessment modalities were valid, in that they reliably discriminated between different levels of training. Objective measures of technical skills are feasible, timely, and improve the validity and reliability of competency assessments.
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Reg Anesth Pain Med · Jan 2007
Disclosure of risks associated with regional anesthesia: a survey of academic regional anesthesiologists.
In view of the relatively few large studies available to estimate the rates of complications following regional anesthesia, we aimed to identify and quantify the risks that academic regional anesthesiologists and regional anesthesia fellows disclose to their patients before performing central and peripheral nerve blockade. ⋯ The risks of regional anesthesia most commonly disclosed to patients by academic regional anesthesiologists and regional anesthesia fellows are benign in nature and occur frequently. Severe complications of regional anesthesia are far less commonly disclosed. The incidences of severe complications disclosed by academic regional anesthesiologists and their fellows can be inconsistent with those cited in the contemporary literature.