Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2010
Randomized Controlled TrialUltrasound provides a reliable test of local anesthetic spread.
We predicted that practitioners could identify injectate spread in a model of ultrasound-guided peripheral nerve block. ⋯ This study shows that ultrasound is a reliable method of detecting injectate spread in a gelatin phantom model.
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Reg Anesth Pain Med · Jul 2010
Prospective survey of patient-controlled epidural analgesia with bupivacaine and hydromorphone in 3736 postoperative orthopedic patients.
Patient-controlled epidural analgesia(PCEA) has been shown to be superior to intravenous patient-controlled analgesics (PCA) for postoperative analgesia after thoracic, abdominal, pelvic, and lower extremity surgery. However, it is unclear which opioid is optimal for PCEA. Hydromorphone has potential advantages, yet there are no data to establish its efficacy and safety. Thus, we prospectively monitored our patients receiving PCEA with bupivacaine combined with hydromorphone after orthopedic surgery. ⋯ Patient-controlled epidural analgesia with bupivacaine and hydromorphone provides effective and safe postoperative analgesia for orthopedic surgery.
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Reg Anesth Pain Med · Jul 2010
The anatomy of the thoracic spinal canal in different postures: a magnetic resonance imaging investigation.
The goal of this study was to investigate,with magnetic resonance imaging, the human anatomic positions of the spinal canal (eg, spinal cord, thecal tissue) in various postures and identify possible implications from different patient positioning for neuraxial anesthetic practice. ⋯ The spinal cord follows the straightest line through the imposed geometry of the spinal canal. Accordingly, there is relatively more posterior separation of the cord and surrounding thecal tissue at midthoracic levels in the apex of the thoracic kyphosis. Placing a patient in a position that accentuates the thoracic curvature of the spine (ie,sitting head-down) increases the posterior separation of the spinal cord and dural sheath at thoracic levels.
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Reg Anesth Pain Med · Jul 2010
Case ReportsNerve injury complicating ultrasound/electrostimulation-guided supraclavicular brachial plexus block.
Neurologic complications after peripheral nerve blocks (PNBs) are relatively uncommon. It has been postulated that real-time, needle-nerve visualization during ultrasound guided PNBs might further reduce the risk of neurologic or vascular complications. ⋯ Ultrasound guidance should not preclude development of additional monitoring and protocols to decrease the risk of complications with PNBs.
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Reg Anesth Pain Med · Jul 2010
Case ReportsFunctional deficits after intraneural injection during interscalene block.
We present an occurrence of a severe but transient neurologic complication after intraneural injection during an ultrasound-guided interscalene block. ⋯ Our report suggests that intraneural injection during ultrasound-guided interscalene block carries a risk of neurologic complications.