Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2008
Case ReportsLimitations and technical considerations of ultrasound-guided peripheral nerve blocks: edema and subcutaneous air.
Despite advantages of ultrasound-guided peripheral nerve blocks as compared with established techniques, various limitations may exist. We present 2 trauma patients in whom the usefulness of ultrasound techniques was limited by edema and subcutaneous air. ⋯ Ultrasound technique limitations do exist. We present 2 conditions, edema and subcutaneous air, which contributed to ultrasound failure to provide a clear image of the targeted nerves.
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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
Randomized Controlled Trial Comparative StudyUltrasound- or nerve stimulation-guided wrist blocks for carpal tunnel release: a randomized prospective comparative study.
We hypothesized that ultrasound-guided wrist blocks may be faster to perform, and may increase success rate, compared with nerve stimulation-guided wrist blocks. ⋯ This randomized prospective study demonstrates that ultrasound-guided wrist nerve blocks are as efficient as those performed with nerve stimulation.
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Reg Anesth Pain Med · Jul 2008
Interactions between pulmonary performance and movement-evoked pain in the immediate postsurgical period: implications for perioperative research and treatment.
Previous data suggest that movement-evoked pain is more closely correlated with pulmonary performance than rest pain beyond 24 hours following lower abdominal surgery. Because adverse alterations in lung physiology are initiated intraoperatively and impact upon pulmonary morbidity, this study tests the hypothesis that movement-evoked pain correlates negatively with pulmonary performance in the immediate postoperative period. ⋯ Considering these and previous results, pulmonary function tests such as PEF should be considered for more routine use as functional surrogates of movement-evoked pain in analgesic trials of thoracic and abdominal surgery. Mechanisms of immediate postoperative movement-evoked pain may differ from those in effect at later time points after which tissue inflammation and spinal sensitization develop. Because pain adversely impacts upon postoperative rehabilitation, these results further imply that aggressive treatment of movement-evoked pain could improve the outcome of postoperative rehabilitation measures if both are implemented very early after surgery.
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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.