Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2011
Comparative StudyNewly designed, self-coiling catheters for regional anesthesia--an imaging study.
A major concern with the use of continuous peripheral nerve block is the difficulty encountered in placing the catheters close enough to the nerves to accomplish effective analgesia. The aim of this study was to investigate if a self-coiling catheter would remain close to the sciatic nerve once introduced through needles placed under ultrasound guidance and if contrast dye injected through the pigtail catheter made direct contact to the nerves. ⋯ By using self-coiling catheters, it is possible to blindly introduce the catheter through needles placed under ultrasound guidance with a low risk of catheter misplacement away from the targeted nerves.
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Reg Anesth Pain Med · Mar 2011
Comparative StudyTensile strength decreases and perfusion pressure of 3-holed polyamide epidural catheters increases in long-term epidural infusion.
Epidural analgesia is an established method for pain management. The failure rate is 8% to 12% due to technical difficulties (catheter dislocation and/or disconnection; partial or total catheter occlusion) and management. The mechanical properties of the catheters, like tensile strength and flow rate, may also be affected by the analgesic solution and/or the tissue environment. ⋯ Epidural catheter use significantly increases the perfusion pressure and decreases the tensile strength.
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Reg Anesth Pain Med · Mar 2011
Case ReportsIpsilateral brachial plexus block and hemidiaphragmatic paresis as adverse effect of a high thoracic paravertebral block.
Thoracic paravertebral block is regularly used for unilateral chest and abdominal surgery and is associated with a low complication rate. ⋯ Brachial plexus block can occur by a route parallel to a nerve connecting the second intercostal nerve and T1 nerve, that is, Kuntz nerve. The hemidiaphragmatic paresis was attributed to the ascending spread of local anesthetic toward the area where the phrenic nerve bypasses the subclavian artery and vein.
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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.