Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2012
Comparative StudyBeyond repeated-measures analysis of variance: advanced statistical methods for the analysis of longitudinal data in anesthesia research.
Research in the field of anesthesiology relies heavily on longitudinal designs for answering questions about long-term efficacy and safety of various anesthetic and pain regimens. Yet, anesthesiology research is lagging in the use of advanced statistical methods for analyzing longitudinal data. The goal of this article was to increase awareness of the advantages of modern statistical methods and promote their use in anesthesia research. ⋯ Based on their advantages over RM-ANOVA, GEE and MEM should be strongly considered for the analysis of longitudinal data. In particular, GEE should be used to explore overall average effects, and MEM should be used when subject-specific effects (in addition to overall average effects) are of primary interest.
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Reg Anesth Pain Med · Jan 2012
Randomized Controlled Trial Comparative StudyUltrasound-guided obturator nerve block: interfascial injection versus a neurostimulation-assisted technique.
Interfascial injection of local anesthetic under ultrasound guidance has been proposed as a new technique for performing an obturator nerve block. We hypothesized that interfascial needle placement could supplant nerve stimulation as the end point for local anesthetic injection during ultrasound-guided obturator nerve block after the division of the obturator nerve. ⋯ In ultrasound-guided obturator nerve block performed after the division of the nerve, injection of local anesthetic between the planes of the adductor muscles is comparable to nerve stimulation.
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Reg Anesth Pain Med · Jan 2012
Regional hemodynamic changes after an axillary brachial plexus block: a pulsed-wave Doppler ultrasound study.
Brachial plexus block (BPB) causes vasodilatation and an increase in blood flow to the ipsilateral upper limb. However, no reports have comprehensively evaluated the regional hemodynamic changes after a BPB. ⋯ Regional hemodynamic changes that occur after an axillary BPB include a change in the morphology of the PWD spectral waveform, arterial vasodilatation, an increase in blood flow velocity, and an increase in blood flow through the ipsilateral brachial artery.
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Reg Anesth Pain Med · Jan 2012
American Society of Regional Anesthesia and Pain Medicine 2010 Gaston Labat Lecture: Perineural catheter analgesia as a routine method after ambulatory surgery--effective but unrealistic.
Adequate postoperative analgesia is a prerequisite for successful ambulatory surgery and remains a challenge. The problem of pain at home may be increasing because previously inpatient surgical procedures are becoming ambulatory and it is expected that the number and complexity of ambulatory surgical procedures will continue to increase. In 1998, we described the use of surgical-site and perineural catheter techniques that allowed patients to self-administer local anesthetics through disposable, elastomeric pumps for pain management at home. ⋯ Surgical-site catheter technique is a simpler, safer, and less expensive alternative and therefore more likely to gain widespread use. Only controlled comparisons can show whether the current belief about the superiority of ambulatory perineural techniques over WCI is justified. Such studies should address technical failures, side effects, home care of the medically unsupervised or undersupervised patient, and cost-effectiveness to demonstrate which of the 2 techniques is most appropriate for a particular procedure.