Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2008
In vitro study of patient's and physician's radiation exposure in the performance of epiduroscopy.
Epiduroscopy is a minimally invasive diagnostic and therapeutic technique, useful in the management of patients with back and leg pain. However, the dose of radiation exposure by fluoroscopy during epiduroscopy is not known. The endpoint of our study was to evaluate the amount of radiation exposure for patients and health care workers during epiduroscopy. ⋯ The radiological dosages in the patient humanoid model were less than the threshold doses that could lead to organ injuries for 1 epiduroscopic procedure. However, care should be taken for cumulative exposures in repeated procedures.
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Reg Anesth Pain Med · Mar 2008
Randomized Controlled Trial Comparative StudyPerioperative interscalene block versus intra-articular injection of local anesthetics for postoperative analgesia in shoulder surgery.
Up to 70% of patients report moderate to severe pain after shoulder surgery, which can compromise early rehabilitation and functional recuperation. Postoperative shoulder pain control is improved with both interscalene block and intra-articular local anesthetic injection. The present study hypothesized that perioperative interscalene analgesia would offer pain control superior to perioperative intra-articular local anesthetics over the first 24 hours after surgery. ⋯ PACU measurements of immediate postoperative pain and narcotic consumption favor perioperative interscalene analgesia over intra-articular analgesia. This benefit does not translate into lower overall pain for the first 24 hours after surgery.
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Reg Anesth Pain Med · Mar 2008
Feasibility of real-time ultrasound for pudendal nerve block in patients with chronic perineal pain.
Compared with conventional fluoroscopic-guided pudendal nerve block, ultrasonography has potential advantages for visualizing anatomical landmarks such as the internal pudendal artery and nerve, the sacrospinous and sacrotuberous ligaments, and local anesthetic spread. We examined the clinical utility of performing pudendal nerve block under real-time ultrasound guidance. ⋯ Pudendal nerve block at the ischial spine level can be reliably performed under real-time ultrasound guidance.
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Reg Anesth Pain Med · Mar 2008
Comparative StudyVariable osteology of the sixth cervical vertebra in relation to stellate ganglion block.
Stellate ganglion block is often carried out using palpation of surface landmarks to guide needle placement. However, anatomic variation of the surface landmarks used is common and block failure has been reported in as many as 30% of patients, even when the surface landmarks that guide needle placement can be easily identified. ⋯ Large variability was observed in the size and location of the landmarks used for needle placement during stellate ganglion block. Placement of the needle medially where the transverse process joins the lateral margin of the vertebral body provides a larger bony target that may potentially provide a safer, more reliable block.