Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2009
Randomized Controlled Trial Multicenter Study Comparative StudyHemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block.
Supraclavicular brachial plexus block is associated with 50% to 67% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether ultrasound-guided compared with nerve stimulation supraclavicular brachial plexus block using 0.75% ropivacaine results in a lower incidence of hemidiaphragmatic paresis. ⋯ Ultrasound-guided supraclavicular brachial plexus block, using 20 mL of 0.75% ropivacaine with the described technique, is not associated with hemidiaphragmatic paresis.
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Reg Anesth Pain Med · Nov 2009
Randomized Controlled Trial Comparative StudyA prospective randomized comparison of ultrasound guidance versus neurostimulation for interscalene catheter placement.
Ultrasound (US) imaging facilitates catheter placement adjacent to the most appropriate elements of the brachial plexus, which for shoulder surgery are the C5YC6 roots or superior trunk. Therefore, it was investigated whether such placement would improve catheter effectiveness compared to placement with traditional techniques. ⋯ After shoulder surgery, interscalene catheters placed with US demonstrated improved effectiveness during the first 24 hrs compared with those placed with NS. These catheters were also placed with less needling and a very small reduction in procedure-related pain.
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Reg Anesth Pain Med · Nov 2009
Randomized Controlled TrialThe transversus abdominis plane block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve analgesia after cesarean delivery.
The transversus abdominis plane (TAP) block has been shown to provide analgesia for lower abdominal wall incisions. We evaluated the efficacy of the TAP block for post-cesarean delivery (CD) patients used as a part of a multimodal regimen. ⋯ The TAP block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve the quality of post-CD analgesia.
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Reg Anesth Pain Med · Nov 2009
Randomized Controlled TrialLess urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia.
It is common practice to catheterize the bladder in the presence of epidural analgesia and to leave the bladder catheter in situ to avoid postoperative urinary retention. However, bladder catheterization carries the risk for urinary tract infection (UTI). The objective of this randomized control trial was to assess whether the incidence of UTI will differ among patients receiving standard care and patients who have the bladder catheterization discontinued on the morning after surgery with the epidural still functioning. ⋯ Leaving the bladder catheter as long as the epidural analgesia is maintained results in a higher incidence of UTI and prolonged hospital stay. Removal of the bladder catheter on the morning after surgery does not lead to higher rate of catheterizations.
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Reg Anesth Pain Med · Nov 2009
Preliminary results of the Australasian Regional Anaesthesia Collaboration: a prospective audit of more than 7000 peripheral nerve and plexus blocks for neurologic and other complications.
Peripheral nerve blockade is associated with excellent patient outcomes after surgery; however, neurologic and other complications can be devastating for the patient. This article reports the development and preliminary results of a multicenter audit describing the quality and safety of peripheral nerve blockade. ⋯ These results indicate that the incidence of serious complications after peripheral nerve blockade is uncommon and that the origin of neurologic symptoms/signs in the postoperative period is most likely to be unrelated to nerve blockade.