Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2009
Vertical infraclavicular brachial plexus block: needle redirection after elicitation of elbow flexion.
In vertical infraclavicular brachial plexus block, success depends on distal flexion or extension response. Initially, elbow flexion (lateral cord) is generally observed. However, specific knowledge about how to reach the medial or posterior cord is lacking. We investigated the mid-infraclavicular area in undisturbed anatomy and tested the findings in a clinical setting. ⋯ In the clinical study, in 98% of cases, the final stimulation response of posterior or medial cord was found as predicted by the findings of the anatomic study. Once elbow flexion is elicited, a further (ie, deeper) advancement of the needle will result in the proper distal motor response.
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Reg Anesth Pain Med · May 2009
Comparative StudyAdverse outcomes associated with stimulator-based peripheral nerve blocks with versus without ultrasound visualization.
In this retrospective study, we queried our Quality Improvement database of anesthetic-related complications to evaluate the frequency of noncatheter peripheral nerve block-related adverse occurrences. We hypothesized that adverse complications of nerve blockade are less common when ultrasonography is used in conjunction with peripheral nerve stimulation to guide needle placement, when compared with the sole use of physical landmarks and nerve stimulation. ⋯ High-definition ultrasonography offers potential advantages in the administration of peripheral nerve blockade. The significant difference in major central nervous system local anesthetic toxicity observed in this study supports the use of ultrasound guidance in conjunction with peripheral nerve stimulation to provide brachial plexus peripheral nerve blockade in an academic, ambulatory anesthesia practice.
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Reg Anesth Pain Med · May 2009
Implications of a permanent cardiac pacemaker in peripheral nerve blockade.
Patients with permanent cardiac pacemakers (PPMs) are vulnerable to electromagnetic interference from electrical equipment used in the operating room environment. Electromagnetic interference may lead to PPM malfunction with potential harmful effects to the patient. ⋯ The hazards of NS, especially when applied near the implanted PPM sites, are not known. In the absence of available guidelines regarding the safe use of NS in the setting of an implanted PPM, we recommend a combined guidance approach for peripheral nerve blockade using ultrasound for nerve localization along with low-current NS for nerve identification.
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Reg Anesth Pain Med · May 2009
Ultrasound of the lateral femoral cutaneous nerve: normal findings in a cadaver and in volunteers.
To assess the feasibility of ultrasound (US) in visualizing the lateral femoral cutaneous nerve (LFCN) in a cadaver and 8 volunteers. ⋯ Ultrasound enables visualization of the LFCN in a cadaver and in volunteers. Ultrasound-guided injection successfully blocked the LFCN.
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Reg Anesth Pain Med · May 2009
Comparative StudySpinal procaine is less neurotoxic than mepivacaine, prilocaine and bupivacaine in rats.
Lidocaine has been reported to be more neurotoxic than other local anesthetics. Alternatives to lidocaine with lower toxicity and shorter duration of action are desirable. Therefore, we compared the histologic and functional changes induced by intrathecal injection of prilocaine, mepivacaine, procaine, and bupivacaine in rats. ⋯ In this animal model, the neurotoxicity of intrathecal procaine was the mildest, and the recovery time to ambulation with procaine was the fastest among the 4 tested anesthetics.