Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2012
Randomized Controlled TrialUltrasound-guided regional anesthesia performance in the early learning period: effect of simulation training.
Success in performing ultrasound-guided peripheral nerve blockade (PNB) demands sound knowledge of sonoanatomy, good scanning techniques, and proper hand-eye coordination. The objectives of our study were to evaluate whether simulator training aids success of novice operators in ultrasound-guided PNB and to determine what number of procedures is required to attain proficiency. ⋯ Simulation training improves success rate in ultrasound-guided performance of regional anesthesia.
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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.
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Reg Anesth Pain Med · Jan 2012
Association of perioperative use of nonsteroidal anti-inflammatory drugs with postoperative myocardial infarction after total joint replacement.
Use of nonsteroidal anti-inflammatory drug (NSAIDs) analgesics is controversial because of cardiovascular risk, but perioperative use may be advantageous for total joint replacement. Thus, we performed this single-center observational cohort study to determine any association between NSAID use and postoperative myocardial infarction (POMI). ⋯ Brief perioperative use of NSAIDs was not associated with increased risk for myocardial infarction after total hip and knee replacement; it may provide benefit in length of stay.
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Reg Anesth Pain Med · Jan 2012
ED50 of hyperbaric bupivacaine with fentanyl for cesarean delivery under combined spinal epidural in normotensive and preeclamptic patients.
The use of reduced intrathecal doses is advised for spinal anesthesia during cesarean delivery. However, there are inadequate data regarding the minimum effective dose of intrathecal bupivacaine for cesarean delivery. Preeclampsia is caused by an endothelial dysfunction leading to generalized vasoconstriction. Whether this can offset the pregnancy-induced decrease in intrathecal dose requirement caused by epidural venous dilation and consequent thecal compression is not known. There are no data to evaluate the minimum effective dose of intrathecal drug for cesarean delivery in preeclamptic patients. This study aimed to determine the minimum effective dose represented by the ED50 of intrathecal hyperbaric bupivacaine for normotensive and severely preeclamptic patients undergoing elective cesarean delivery. ⋯ When a combined-spinal epidural is planned in normotensive or severely preeclamptic patients for an elective cesarean delivery, the ED50 of intrathecal hyperbaric bupivacaine along with 20 μg of fentanyl is 4.7 mg.