Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2009
Randomized Controlled Trial Comparative StudyClinical impact of epidural anesthesia simulation on short- and long-term learning curve: High- versus low-fidelity model training.
Epidural anesthesia is a technically challenging regional anesthetic technique that can be difficult to teach to novices. Epidural simulators are now available to allow realistic training within a safe and controlled environment before attempting the procedure on patients. Potentially, this may improve skill acquisition by novice residents. The purpose of this study was to examine the effect of a high-fidelity epidural anesthesia simulator on residents' ability to perform their first labor epidurals and on their learning curve compared with a group having training with a low-fidelity model. ⋯ Our study shows that a simple model can be as useful for learning how to place an epidural catheter as an expensive anatomically correct simulator. New and more technologically advanced simulators should be compared against lower fidelity models to establish their utility and cost-effectiveness.
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Reg Anesth Pain Med · May 2009
Minimal local anesthetic volume for peripheral nerve block: a new ultrasound-guided, nerve dimension-based method.
Nerve blocks using local anesthetics are widely used. High volumes are usually injected, which may predispose patients to associated adverse events. Introduction of ultrasound guidance facilitates the reduction of volume, but the minimal effective volume is unknown. In this study, we estimated the 50% effective dose (ED50) and 95% effective dose (ED95) volume of 1% mepivacaine relative to the cross-sectional area of the nerve for an adequate sensory block. ⋯ Based on the ultrasound measured cross-sectional area and using ultrasound guidance, a mean volume of 0.7 mL represents the ED95 dose of 1% mepivacaine to block the ulnar nerve at the proximal forearm.
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Reg Anesth Pain Med · May 2009
Clinical TrialMinimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block.
The aim of this study was to determine the minimum effective anesthetic volume required to produce an effective supraclavicular block for surgical anesthesia using an ultrasound (US)-guided technique. ⋯ In this study, the minimum volume required for US-guided supraclavicular block in 50% of patients was 23 mL, and in 95% of patients was 42 mL. Under the present study conditions, the calculated volume of LA required for US-guided supraclavicular block does not seem to differ from the conventionally recommended volume required for supraclavicular blocks using non-US-based nerve localization techniques.
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Reg Anesth Pain Med · May 2009
Ultrasound-guided obturator nerve block: an interfascial injection approach without nerve stimulation.
For knee surgery, obturator nerve block (ONB) has been shown to enhance postoperative analgesia provided by femoral block. Current techniques for obturator block use surface landmarks or ultrasound guidance (USG) with nerve stimulation. This preliminary observational study evaluated the success of an ultrasound-guided ONB without the additional use of nerve stimulation. ⋯ Obturator nerve block using USG to achieve interfascial injection without nerve stimulation had success similar to that reported in studies using nerve stimulation.