Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2011
Comparative StudyUncomplicated removal of epidural catheters in 4365 patients with international normalized ratio greater than 1.4 during initiation of warfarin therapy.
Current guidelines from the American Society of Regional Anesthesia state that an international normalized ratio (INR) of 1.4 is the upper limit of warfarin anticoagulation for safe removal of an epidural catheter. However, these guidelines are based primarily on expert consensus, and there is controversy regarding this recommendation as being "too conservative." ⋯ Our series of 4365 patients had uncomplicated removal of epidural catheters despite INRs ranging from 1.5 to 5.9. Removal was only during initiation of warfarin therapy (up to approximately 50 hrs after warfarin intake) when several vitamin K factors are likely to still be adequate for hemostasis.
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Reg Anesth Pain Med · May 2011
ReviewNeedle to nerve proximity: what do the animal studies tell us?
Recent animal studies have provided insight and understanding, as well as promising clinical tools, to help identify needle-to-nerve contact and potentially hazardous intraneural injection. This narrative review describes and summarizes the contemporary animal studies primarily relating to indicators of needle-to-nerve contact and intraneural injection. Resultant nerve injury, whenever sought, is discussed.
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Reg Anesth Pain Med · May 2011
Comparative StudyMorphologic study of nerve root and types of needle used in transforaminal injections.
The bevel type and location of the distal orifice of the needle may have relevance for potential complications occurring during transforaminal epidural injection. ⋯ The layer of fat around nerve roots may prevent the contact of the needle tip with axons. The sharp needle tip entered the nerve root cuff more easily than the blunt tip in the cadaveric nerve root samples, measured in a qualitative manner. There is a need for clinical studies to ascertain if blunt needles may be safer than sharp needles for transforaminal injections.
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Reg Anesth Pain Med · May 2011
Editorial CommentThat bow is perfect, but your shoes are on the wrong feet.