Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Comparative StudyPosterior versus anterolateral approach interscalene catheter placement: a prospective randomized trial.
Two distinctly different approaches to interscalene catheter placement have been in common use for close to a decade. This prospective randomized study tested the hypothesis that interscalene catheters placed using the posterior approach would provide a more effective analgesia after shoulder surgery compared with catheters placed using the anterolateral approach. ⋯ Anterolateral interscalene catheters perform more effectively and are procedurally more easily placed compared with catheters placed using the posterior approach.
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Reg Anesth Pain Med · Mar 2011
Randomized Controlled Trial Comparative StudyEchogenic technology can improve needle visibility during ultrasound-guided regional anesthesia.
Needle tip visualization is fundamental to the safety and efficacy of ultrasound-guided regional anesthesia (UGRA). It can be extremely challenging especially at steep insertion angles. We assessed whether an echogenic needle improved tip visibility during UGRA by anesthesiologists performing their normal in-plane technique. ⋯ Tip visibility with the Sonoplex was independent of insertion angle over the range studied (0-57 degrees, P=0.95). This finding occurred when nonexpert anesthesiologists performed their standard UGRA technique. A needle that is visible for a greater percentage of time has potential safety and efficacy implications.
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Reg Anesth Pain Med · Mar 2011
Comparative StudyProgression of forearm intravenous regional anesthesia with ropivacaine.
The progression of sensory blockade in the hand following a forearm Bier block with ropivacaine is currently unknown. The hands of 10 healthy adult human subjects were anesthetized with ropivacaine, and their sensitivities to cold and touch were tested until the completion of anesthesia. On average, insensitivity to cold occurred uniformly throughout the hand within 9 mins; however, touch sensation was not complete until approximately 20 mins after injection. The spread of anesthesia occurred in a semisystematic way, spreading proximally and distally from the site of injection (mid-dorsum of the hand), and, at a slower rate, from the dorsum of the hand to the palm.
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Reg Anesth Pain Med · Mar 2011
Comparative StudyDirect connections between the spinal epidural space and the venous circulation in humans.
Our previous studies in pigs indicate that direct connections exist between the spinal epidural space and the venous circulation. We wondered if similar connections occur in humans and have extended our investigations to human cadavers awaiting autopsy. ⋯ A direct connection between the spinal epidural space and the venous circulation has been demonstrated in human cadavers. The connection is most commonly found in the cervical and upper thoracic spine.
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Reg Anesth Pain Med · Mar 2011
Comparative StudyMinimum effective volume of lidocaine for ultrasound-guided infraclavicular block.
The aim of this study was to determine the minimum effective volume of lidocaine 1.5% with epinephrine 5 μg/mL in 90% of patients (MEV(90)) for single-injection ultrasound-guided infraclavicular block (ICB). ⋯ For single-injection ultrasound-guided ICB, the MEV(90) of lidocaine 1.5% with epinephrine 5 μg/mL is 35 mL. Further dose-finding studies are required for other concentrations of lidocaine, other local anesthetic agents as well as techniques involving multiple injections, a more medial approach to ICB, or precise location of all 3 cords of the brachial plexus.