Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2011
ReviewUltrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures. Part III: shoulder.
Application of ultrasound for musculoskeletal injections is increasingly popular. The common targets for shoulder injection are the subacromial subdeltoid bursa, glenohumeral joint, acromioclavicular joint, and the long head of biceps tendon. This review describes and summarizes the anatomy and sonoanatomy relevant to the injection of these structures. The feasibility, accuracy, and effectiveness of the injections into and around these shoulder structures, as well as the injection techniques, are also described in detail.
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Reg Anesth Pain Med · Nov 2011
Comparative StudyPerineural ultrasound-guided catheter bacterial colonization: a prospective evaluation in 747 cases.
Ultrasound guidance is increasingly used for catheter insertion and could make it more complicated to guarantee aseptic insertion of catheters. The current study evaluated the incidence of colonization of ultrasound-guided perineural catheter (US-PNC) placed for postoperative analgesia. ⋯ Although infection rate is low, there is a risk of ultrasound-guided catheter colonization that deserves careful monitoring of the insertion site in the postoperative period.
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Reg Anesth Pain Med · Nov 2011
Comparative StudyUnintentional subdural placement of epidural catheters during attempted epidural anesthesia: an anatomic study of spinal subdural compartment.
Although infrequent, subdural block is a complication of epidural anesthesia with obvious implications. Knowledge of the spinal subdural compartment (dura-arachnoid interface) may help elucidate controversies arising from evidence that subdural catheter placement is feasible and may be difficult to identify clinically. ⋯ Dura mater and arachnoid layers act as a single unit but may be pulled apart by traction forces during cadaver processing of the dural sac or in vivo placement of catheters. This generates subdural spaces, either parallel or concentric, because of the minimal resistance offered by the tissue, which may be explained by its few specialized membrane junctions.
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Reg Anesth Pain Med · Nov 2011
Ultrasound anatomy of the nerves supplying the cervical zygapophyseal joints: an exploratory study.
Nerve blocks and radiofrequency neurotomy of the nerves supplying the cervical zygapophyseal joints are validated tools for diagnosis and treatment of chronic neck pain, respectively. Unlike fluoroscopy, ultrasound may allow visualization of the target nerves, thereby potentially improving diagnostic accuracy and therapeutic efficacy of the procedures. The aims of this exploratory study were to determine the ultrasound visibility of the target nerves in chronic neck pain patients and to describe the variability of their course in relation to the fluoroscopically used bony landmarks. ⋯ The medial branches and their relation to the fluoroscopically used bony targets were mostly visualized by ultrasound, with the exception of the medial branch of C7 and, to a lesser extent, the bony target of C7. The nerve location may be distant from the fluoroscope's target. These findings justify further studies to investigate the validity of ultrasound guided blocks for invasive diagnosis/treatment of cervical zygapophyseal joint pain.
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Reg Anesth Pain Med · Nov 2011
Comparative StudyInhibition of voltage-gated sodium channels by emulsified isoflurane may contribute to its subarachnoid anesthetic effect in beagle dogs.
Volatile anesthetics, in addition to their general anesthesia action, have been proven to produce regional anesthetic effect in various animal models. The major aim of this study was to examine whether emulsified isoflurane (EI) could also produce subarachnoid anesthesia and to investigate its possible mechanism. ⋯ Emulsified isoflurane produced dose-dependent subarachnoid anesthesia, and this effect might be mediated by inhibition of EI on voltage-gated Na channels in the spinal cord.