Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2012
Comparative StudyOptical detection of vascular penetration during nerve blocks: an in vivo human study.
Complications resulting from vascular penetration during nerve blocks are rare but potentially devastating events that can occur despite meticulous technique. In this in vivo human pilot study, we investigated the potential for detecting vascular penetration with optical reflectance spectroscopy during blocks of the sympathetic chain and the communicating ramus at lumbar levels. ⋯ The results from this study suggest that optical spectroscopy has the potential to detect intravascular needle placement, which may in turn increase the safety of nerve blocks.
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Reg Anesth Pain Med · Jan 2012
Randomized Controlled TrialASRA checklist improves trainee performance during a simulated episode of local anesthetic systemic toxicity.
Severe local anesthetic systemic toxicity (LAST) is a rare event, the management of which might best be learned using high-fidelity simulation. In its 2010 Practice Advisory, the American Society of Regional Anesthesia and Pain Medicine (ASRA) created a medical checklist to aid in the management of LAST. We hypothesized that trainees provided with this checklist would manage a simulated episode of LAST more effectively than those without it. A secondary aim of the study was to assess the ASRA Checklist's usability and readability. ⋯ Use of the ASRA Checklist significantly improved the trainees' medical management and nontechnical performance during a simulated episode of severe LAST. Partial use of the checklist correlated with lower overall performance.
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Reg Anesth Pain Med · Jan 2012
Three-dimensional/four-dimensional volumetric ultrasound imaging of the sciatic nerve.
Currently, there are limited data on the use of 3-dimensional ultrasound to image peripheral nerves. We undertook this imaging study to determine the feasibility of using 3-dimensional ultrasound imaging to delineate the anatomy of the sciatic nerve. ⋯ We have demonstrated that it is feasible to perform 3-dimensional ultrasound imaging of the sciatic nerve. The anatomic information obtained is more detailed than that with a 2-dimensional scan, which provides better insight into the spatial relationship of the sciatic nerve with its surrounding structures. A distinct "perineural space" was also identified alongside the course of the sciatic nerve, which may play a significant role in sciatic nerve blockade.