Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2008
Evaluation of magnetic resonance imaging following neuraxial steroid administration: does epidural injection produce pathologic findings?
Infection or hematoma following epidural anesthesia is a rare but potentially devastating complication unless diagnosed early. In order to diagnose spinal cord involvement, the currently recommended imaging test is magnetic resonance imaging (MRI). Despite this, no previous studies have been performed to define typical MRI findings following uneventful epidural injection. The purpose of this pilot study was to compare magnetic resonance images before and after epidural injection to define the characteristic appearance of MRI following an uneventful epidural steroid injection. ⋯ The results of this pilot study demonstrated that after uneventful epidural injection in otherwise healthy patients, there were no new pathologic findings on MRI scans. Further MRI studies in large populations and in different clinical situations should be performed to confirm these preliminary findings.
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Reg Anesth Pain Med · Jul 2008
Case ReportsSpinal cord injury produced by direct damage during cervical transforaminal epidural injection.
Cervical transforaminal epidural steroid injection (TFESI) has become a common treatment for cervical radiculopathy. We describe a case of spinal cord injury caused by direct injection of iohexol into the cervical spinal cord during cervical TFESI. ⋯ This case report draws attention to this very serious complication of cervical TFESI. It is essential to confirm final needle position using both anteroposterior and lateral fluoroscopy before any injection through the needle.
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Reg Anesth Pain Med · Jul 2008
Case ReportsCase report: limitation of local anesthetic spread during ultrasound-guided interscalene block. Description of an anatomic variant with clinical correlation.
The use of ultrasound (US) for localization of neural structures allows real-time visualization of anatomy; however, variability in the arrangement of structures has been observed. The impact of these variations on the performance and outcome of regional anesthetic techniques remains unclear. We discuss possible anatomic explanations and correlation with clinical observations. ⋯ This case illustrates the ability of US to identify anatomic variations and their relevance to the performance of regional anesthetic techniques.
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Reg Anesth Pain Med · Jul 2008
The sensitivity of motor response to needle nerve stimulation during ultrasound guided interscalene catheter placement.
Neurostimulation during single shot interscalene block has a significant false negative motor response rate. Compared with tangential needle approaches for single shot block, interscalene catheter (ISC) placement commonly involves Tuohy needles inserted longitudinally to the brachial plexus. This study aimed to determine the sensitivity of neurostimulation during ultrasound-guided ISC needle placement, and the feasibility of an ultrasound-guided ISC needle endpoint. ⋯ This study suggests that the false negative motor response rate for longitudinal ISC needle placement is higher than the false negative response rate associated with tangential needle approach interscalene block. An ultrasound guided ISC needle endpoint is a feasible alternative to a neurostimulation endpoint.