Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2012
Randomized Controlled TrialA 3-dimensional ultrasound study of local anesthetic spread during lateral popliteal nerve block: what is the ideal end point for needle tip position?
Recent clinical trials suggest that subfascial (sometimes termed subepineural) injections result in faster block onset and success compared with conventional techniques. This prospective, randomized, observer-blinded study measured and compared the 3-dimensional spread pattern and volume of perineural local anesthetic (LA) in contact with the sciatic nerve after subfascial versus extrafascial lateral popliteal injections. ⋯ Placement of the needle tip beneath the complex fascial sheath of the sciatic nerve resulted in significantly greater perineural local anesthetic volume following a single-injection lateral popliteal approach at the nerve bifurcation and was associated with greater sensory blockade and a characteristic laminar LA spread pattern.
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Reg Anesth Pain Med · Nov 2012
Three-times-daily subcutaneous unfractionated heparin and neuraxial anesthesia: a retrospective review of 928 cases.
Subcutaneous (SC) unfractionated heparin (UFH) administered 3 times daily (TID) is widely used for venous thromboembolism prophylaxis in the perioperative period. There are no data in the literature regarding the incidence of adverse outcomes with neuraxial analgesia in the setting of this regimen. In this retrospective review, we report the incidence of untoward events related to anticoagulation with SC UFH TID in patients with indwelling epidural catheters. ⋯ Given the rare incidence of neuraxial hematoma, statements regarding the appropriateness of epidural analgesia in the setting of TID SC UFH cannot be made from this limited sample size. At present, information regarding epidural hematoma in the setting of a TID SC UFH dosing regimen does not exist in the literature. Our study represents an initial step in the accumulation of data needed to prove or disprove the safety of this practice.
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Reg Anesth Pain Med · Nov 2012
Effect of acute versus continuous glycemic control on duration of local anesthetic sciatic nerve block in diabetic rats.
The duration of nerve block is longer in streptozotocin (STZ)-induced diabetic rats for all local anesthetics (with and without adjuvants) compared with normal rats. Perioperative glycemic control is currently practiced to reduce adverse events in many at-risk patients, especially in diabetic patients, to prevent neuropathy, poor wound healing, and greater incidence of infection. The aim of this study was to investigate in diabetic rats the importance of glycemic control before peripheral nerve block. ⋯ With continuous glycemic control in diabetic rats, the duration of sensory and motor nerve block was about 40 minutes shorter than that in the untreated diabetic rats and similar to that of normal rats. However, acute glycemic control did not affect nerve block duration, suggesting that this neuropathy cannot be rapidly reversed.
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Reg Anesth Pain Med · Nov 2012
Education in regional anesthesia: caseloads, simulation, journals, and politics: 2011 Carl Koller Lecture.
This special article is an essay version of the European Society of Regional Anaesthesia and Pain Therapy 2011 Carl Koller Award lecture. Historically, evaluations of a trainee's regional anesthesia learning focused on caseload numbers. The deficiency of this unidimensional approach is that case numbers alone say little about the resident's mastery of the nontechnical aspects of regional anesthesiology. ⋯ Journals play an important role in regional anesthesia education for both trainees and mature anesthesiologists. Editorial boards build valuable educational foundations by providing critical analysis of new technologies and sponsoring practice advisories. Subspecialty societies such as European Society of Regional Anaesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine foster regional anesthesia education through their efforts to define curricula, produce guidelines, and promote international collaboration.