Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2010
Spinal Anesthesia and Intrathecal Clonidine Decrease the Hypnotic Requirement of Propofol.
Spinal anesthesia and intrathecal clonidine are known to have hypnotic effects. We investigated the effect of spinal anesthesia and intrathecal clonidine on the requirement of propofol for sedation. ⋯ Spinal anesthesia and intrathecal clonidine might reduce the requirement of propofol for sedation. Our study showed target concentrations of propofol for sedation of 1.4 to 1.7 using local anesthesia only, 1.1 to 1.4 using spinal anesthesia with bupivacaine, and 0.7 to 0.9 microg/mL using spinal anesthesia with bupivacaine and 75 microg of clonidine
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Reg Anesth Pain Med · Mar 2010
ReviewEvidence-based medicine: Assessment of ultrasound imaging for regional anesthesia in infants, children, and adolescents.
This review was performed to evaluate and discuss the quality and outcomes of studies assessing ultrasound imaging in pediatric regional anesthesia. Literature searches were conducted using MEDLINE and EMBASE, combining the search term "ultrasonography" with "regional anesthesia," "nerve block," "epidural anesthesia," and "spinal anesthesia," with the limit of 0 to 18 years. ⋯ The search resulted in 211 total publications in pediatric literature, of which 12 were included in the evaluation of peripheral nerve blocks and 12 in the evaluation of neuraxial anesthesia. Although there is some evidence to support ultrasound for various outcomes in pediatric regional anesthesia, more randomized controlled studies with sufficient power are required to further support these findings and to evaluate the potential for ultrasound to reduce complications for regional anesthesia in children.
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Reg Anesth Pain Med · Mar 2010
ReviewEvidence-based medicine: ultrasound guidance for truncal blocks.
We performed a systematic search of the medical literature and reviewed the evidence examining success rates and incidence of complications of ultrasound (US) guidance relative to traditional techniques for the following blocks: paravertebral, intercostal, transversus abdominis plane, rectus sheath, and ilioinguinal/iliohypogastric. We included studies of sufficient methodologic quality for review and excluded poor-quality studies. ⋯ Although relatively few studies have compared US guidance with established techniques, the available evidence suggests that the use of US guidance is a safe and effective means to facilitate correct needle placement and adequate spread of local anesthetic for truncal blocks. Further studies are needed to directly compare US guidance to traditional techniques and to clarify potential benefits and limitations of US guidance for truncal blocks.
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Reg Anesth Pain Med · Mar 2010
ReviewEvidence basis for ultrasound-guided block characteristics: onset, quality, and duration.
This systematic review summarizes existing evidence for superior onset, quality, and duration of block for ultrasound (US) guidance versus other techniques for nerve localization. ⋯ There is level 1b evidence to make a grade A recommendation that US guidance provides a modest improvement in block onset and quality of peripheral nerve blocks. Ultrasound is rarely inferior to other techniques.
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Reg Anesth Pain Med · Mar 2010
ReviewUltrasound-guided regional anesthesia and patient safety: An evidence-based analysis.
The role of ultrasound-guided regional anesthesia (UGRA) in reducing the frequency of regional anesthetic-related complications is difficult to ascertain from analyzing the limited literature on the topic. This evidence-based review critically evaluates the contributions of UGRA to improved patient safety, particularly as compared with standard nerve localization tools. Randomized controlled trials that compared UGRA with another form of neural localization and case series of more than 500 patients were used to compare safety parameters. ⋯ Statistical proof for meaningful reduction in the frequency of extremely rare complications, such as permanent peripheral nerve injury, is likely unattainable. Although there is evidence for UGRA reducing the occurrence of vascular puncture and the frequency of hemidiaphragmatic paresis, as yet there is at best inconclusive scientific proof that these surrogate outcomes are linked to actual reduction of their associated complications, such as local anesthetic systemic toxicity or predictable diaphragmatic impairment in at-risk individuals. This evidence-based review thus strives to summarize both the power and the limitations of UGRA as a tool for improving patient safety.