Regional anesthesia and pain medicine
-
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.
-
Reg Anesth Pain Med · Nov 2009
Minimum current requirements for epidural stimulation test confirmation of epidural and intrathecal catheter placement.
The typical blind insertion of a catheter into the epidural space risks catheter misplacement into the intrathecal space. The epidural stimulation test is designed to confirm the correct epidural location of a catheter but may also detect unintended intrathecal catheter placement by evaluating the minimum electrical current required for appropriate motor stimulation. Using this test, we observed the minimum current requirements for appropriate motor stimulation of catheters placed in the epidural and intrathecal spaces. ⋯ We conclude that the epidural stimulation test minimum electrical current requirement seems to be lower for intrathecal compared with epidural catheter placement.
-
Reg Anesth Pain Med · Nov 2009
Feasibility and efficacy of ultrasound-guided block of the saphenous nerve in the adductor canal.
Saphenous nerve (SN) block can be technically challenging because it is a small and exclusively sensory nerve. Traditional techniques using surface landmarks and nerve stimulation are limited by inconsistent success rates. This descriptive prospective study assesses the feasibility of performing an ultrasound-guided SN block in the distal thigh. ⋯ In this small descriptive study, ultrasound-guided SN block in the adductor canal was technically simple and reliable, providing consistent nerve identification and block success.
-
Spinal ultrasound offers valuable information to facilitate the placement of lumbar neuraxial anesthesia. Lumbar spine sonograms are unique, and aspects may appear atypical at times, particularly the ligamentum flavum (LF). The objective of this study was to describe the sonoanatomy of the lumbar spine and to determine the frequency of atypical images of the LF in pregnant women at term. ⋯ The paramedian longitudinal sonograms of the lumbar spine are of superior quality to those obtained in the transverse plane. When using the transverse approach, a high incidence of inconclusive sonograms should be expected in the lower segments. The incidence of atypical LF images, especially in the upper lumbar segments, warrants further investigation because it can have implications for the epidural technique.
-
Reg Anesth Pain Med · Nov 2009
Comparative StudyRedistribution of tissue blood flow after stellate ganglion block in the rabbit.
The goal of this study was to compare tissue blood flow at various sites before and after stellate ganglion block (SGB) and to discuss the redistribution of tissue blood flow after SGB. ⋯ These results indicate that lower limb and visceral blood flow as well as blood flow on the nonblock side are redistributed to the block side after SGB. Redistribution from peripheral tissue may have a more important role than that of visceral blood flow redistribution after SGB.