Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2010
Randomized Controlled Trial Comparative StudyA double-blind, controlled, randomized trial to evaluate the efficacy of botulinum toxin for the treatment of lumbar myofascial pain in humans.
Among all the causes of chronic low back pain, myofascial pain syndrome of the spinal stabilizer muscles is one of the most frequent, yet underconsidered sources of pain. The purpose of this prospective, randomized, double-blind, controlled trial was to evaluate the efficacy of type-A botulinum toxin (BTX-A) in relieving myofascial pain in patients experiencing mechanical low back pain due to bilateral myofascial pain syndrome involving the iliopsoas and/or the quadratus lumborum muscles. ⋯ BTX-A seems to provide significant postintervention pain relief. However, considering its high cost and the small differences compared with control treatments, its use should be reserved only for patients with pain refractory to other invasive treatments.
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Reg Anesth Pain Med · May 2010
ReviewClinical sonopathology for the regional anesthesiologist: part 1: vascular and neural.
The use of ultrasound to facilitate regional anesthesia is an evolving area of clinical, education, and research interests. As our community's experience grows, it has become evident that anesthesiologists performing "routine" ultrasound-guided blocks may very well be confronted with atypical or even pathologic anatomy. As an educational resource for anesthesiologists, the following articles present examples of common sonopathology that may be encountered during ultrasound-guided regional anesthesia. This present article describes sonopathology related to blood vessels and nerves.
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This report describes the production of a low-cost ultrasound phantom of the lumbosacral spine. The phantom should be a very useful tool to teach the basic skills for ultrasound-guided procedures of the lumbosacral spine. ⋯ This teaching tool can provide trainees with an opportunity to familiarize themselves with sonoanatomy of the lumbosacral spine in addition to practicing probe handling techniques and needle placement.
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Reg Anesth Pain Med · May 2010
Revisiting anatomic landmarks: lateral popliteal approach for sciatic nerve block based on magnetic resonance imaging.
When the conventional lateral popliteal sciatic nerve (SN) block is performed, the needle angle required to localize and the level of the SN bifurcation are highly variable. The aim of our magnetic resonance imaging (MRI) study was to determine the most common range of needle-insertion angles and the relationship between skin-to-femur distance and angle. We also evaluated the variability of the SN bifurcation level and the relationship between patient height and nerve bifurcation level. ⋯ Our simulated lateral popliteal SN block on MRIs shows a 15- to 45-degree range of needle-insertion angles. As the skin-to-femur distance was greater than 4.5 cm, the angles were progressively smaller than 30 degrees. Although this was an MRI study, it does provide some evidence that indicates the conventional clinically recommended 25- to 30-degree-angle ranges may need to be reevaluated. Needle insertion of 10 cm or greater proximal to the popliteal crease may increase the chance of placement at or proximal to the SN bifurcation.