Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2008
Practice GuidelineASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine.
Neurologic complications associated with regional anesthesia and pain medicine practice are extremely rare. The ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine addresses the etiology, differential diagnosis, prevention, and treatment of these complications. This Advisory does not focus on hemorrhagic and infectious complications, because they have been addressed by other recent ASRA Practice Advisories. The current Practice Advisory offers recommendations to aid in the understanding and potential limitation of neurologic complications that may arise during the practice of regional anesthesia and pain medicine.
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Reg Anesth Pain Med · Sep 2008
Case ReportsLong-axis ultrasound imaging of the nerves and advancement of perineural catheters under direct vision: a preliminary report of four cases.
Ultrasound allows visualization of in plane needle insertion toward a nerve and the perineural spread of local anesthetic (LA) solution. However, advancement and final positioning of perineural catheters is difficult to visualize. We assessed the feasibility of long axis nerve scans for controlling perineural catheter placement. ⋯ This short case series suggests that long axis imaging of the nerve, the needle, and the catheter allows visualization of a catheter's advancement. Using to-and-fro movements, and slight rotation the needle's bevel, the catheter may be maneuvered under the ultrasound beam, which facilitates correct positioning.
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Reg Anesth Pain Med · Sep 2008
Biography Historical ArticleCentennial of intravenous regional anesthesia. Bier's Block (1908-2008).
The surgeon August Gustav Bier significantly influenced surgery, general medicine, and especially anesthesia. He was the father of spinal anesthesia (1898) and intravenous regional anesthesia (1908). ⋯ On the occasion of the centennial anniversary of the first use of intravenous regional anesthesia it is appropriate to recall Bier's contribution to the repertoire of anesthesiologists. The evolutionary history of both the injected drugs and the refinements of the technique are elaborated upon.
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A peripheral nerve or spinal cord injury is a rare but significant complication of regional anesthesia. Evaluation of acute nerve injury includes a focused history and examination to localize the lesion. Confirmatory testing should include electromyography and appropriate imaging. ⋯ The prognosis for cauda equina or spinal cord lesions is more guarded. Recovery from these is commonly incomplete. Early diagnosis and intervention is the key to preventing catastrophic neurological outcomes.
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Reg Anesth Pain Med · Sep 2008
Comment Letter Case ReportsEight ball, corner pocket ultrasound-guided supraclavicular block: avoiding a scratch.