Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2008
Successful continuous interscalene analgesia for ambulatory shoulder surgery in a private practice setting.
Large prospective studies evaluating continuous interscalene block for shoulder surgery have thus far been limited to inpatient and university teaching practices. Shoulder surgery is increasingly being performed on an outpatient basis. The aim of this case series was to prospectively evaluate a large series of interscalene catheters for ambulatory shoulder surgery in a private practice setting. ⋯ Continuous interscalene block for ambulatory shoulder surgery in a private practice setting had a high success rate, a low complication rate, and enabled the avoidance of the use of potent opioids in 98% of patients.
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Conflicting definitions concerning the exact location of the lumbar plexus have been proposed. The present study was carried out to detect anatomical variants regarding the topographical relation between the lumbar plexus and the psoas major muscle as well as lumbar plexus anatomy at the L4-L5 level. ⋯ Our results synthesize contrasting assumptions in previous literature, by demonstrating that both locations of the lumbar plexus may be encountered in clinical practice: within and posterior to the psoas major muscle. However, the latter situation represents a minor variant. At the level of L4-L5 the femoral nerve, showing a remarkable degree of branching, as well as the obturator nerve, were found within the psoas major muscle in the vast majority of specimens.
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Reg Anesth Pain Med · Mar 2008
Case ReportsEarly intralipid therapy may have prevented bupivacaine-associated cardiac arrest.
Local anesthetic-induced cardiotoxicity remains a complication of regional anesthesia, with the potential to result in cardiac arrest refractory to resuscitation. Successful resuscitation using Intralipid (Baxter Pharmaceuticals by Fresenius Kabi, Uppsala, Sweden), has been reported in 2 patients with bupivacaine-induced cardiac arrest. ⋯ Early treatment with Intralipid may help prevent cardiac arrest and speed successful resuscitation efforts.