Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2008
Randomized Controlled Trial Comparative StudyUltrasound guided fascia iliaca block: a comparison with the loss of resistance technique.
The aim of this study was to compare the efficacy of fascia iliaca block, performed by loss of resistance and ultrasound guidance techniques. ⋯ Ultrasound-guided fascia iliaca block increased the frequency of sensory loss in the medial aspect of the thigh. Ultrasound guidance also increased the frequency of femoral and obturator motor block.
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Reg Anesth Pain Med · Nov 2008
A pre-emptive multimodal pathway featuring peripheral nerve block improves perioperative outcomes after major orthopedic surgery.
Patients undergoing major orthopedic surgery experience significant postoperative pain. Failure to provide adequate analgesia may impede early physical therapy and rehabilitation, which are important factors for maintaining joint range of motion and facilitating hospital dismissal. We examined the effect of a pre-emptive, multimodal, perioperative analgesic regimen emphasizing peripheral nerve block in patients undergoing total hip (THA) and total knee (TKA) arthroplasty. Perioperative outcomes and major postoperative complications were evaluated. ⋯ Patients undergoing THA or TKA using a comprehensive, pre-emptive, multimodal analgesic regimen emphasizing peripheral nerve block may have significantly improved perioperative outcomes, and fewer adverse events, when compared with patients receiving traditional intravenous opioids during the initial postoperative period. Improved perioperative outcomes include a shortened hospital length of stay, and a significant reduction in postoperative urinary retention and ileus formation.
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Reg Anesth Pain Med · Nov 2008
Comparative StudyFeasibility of ultrasound-guided percutaneous placement of peripheral nerve stimulation electrodes and anchoring during simulated movement: part two, upper extremity.
Peripheral nerve stimulation (PNS) may provide analgesia for neuropathic pain syndromes in that nerve distribution. PNS electrode placement using ultrasound (US) guidance for upper extremity pain syndromes has not been reported. Existing anchoring technology may allow permanent implantation without significant migration. ⋯ This new minimally invasive approach to lead placement requires further study to determine implantation criteria, optimal locations, anchoring techniques, and electrode design to define best clinical practice.
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Reg Anesth Pain Med · Nov 2008
An ultrasound study of the phrenic nerve in the posterior cervical triangle: implications for the interscalene brachial plexus block.
Concomitant phrenic nerve block frequently occurs after brachial plexus block procedures in the neck and can result in substantial morbidity. In this study we sought to establish the anatomic basis using ultrasound imaging. ⋯ This descriptive study found that the phrenic nerve and brachial plexus are within 2 mm of each other at the cricoid cartilage level, with additional 3 mm separation for every cm more caudal in the neck. Clinical trials with imaging guidance are needed to establish whether brachial plexus selective blocks can be consistently achieved above the clavicle.