Regional anesthesia and pain medicine
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A critical challenge encountered in interventional pain medicine procedures is to accurately and efficiently identify transitions to peripheral nerve targets. Current methods, which include ultrasound guidance and nerve stimulation, are not perfect. In this pilot study, we investigated the feasibility of identifying tissue transitions encountered during insertions toward peripheral nerve targets using optical spectroscopy. ⋯ The results indicate that the spectroscopic information provided by the needle stylet could potentially allow for reliable identification of transitions from subcutaneous fat to skeletal muscle and from the muscle to the nerve target region during peripheral nerve blocks.
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Reg Anesth Pain Med · May 2012
ReviewPulsed radiofrequency in the treatment of persistent pain after inguinal herniotomy: a systematic review.
In the United States, it is estimated that between 6000 and 18,000 individuals each year present with disabling pain after inguinal hernia repair. Although surgical treatment with mesh removal is one of few options available, effective alternatives to nonsurgical management are needed. The use of pulsed radiofrequency (PFR), leading to nondestructive lesions of nerve structures, has been proposed as a treatment option. ⋯ Pain relief varied between 63% and 100%, the follow-up period was 3 to 9 months, and no adverse effects or complications were reported. In conclusion, the evidence base of PRF in persistent pain after inguinal herniotomy is fairly limited. Suggestions for improved research strategies are presented.
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Reg Anesth Pain Med · May 2012
Ultrasound-guided suprascapular nerve block, description of a novel supraclavicular approach.
The suprascapular nerve (SSN) block is frequently performed for different shoulder pain conditions and for perioperative and postoperative pain control after shoulder surgery. Blind and image-guided techniques have been described, all of which target the nerve within the supraspinous fossa or at the suprascapular notch. This classic target point is not always ideal when ultrasound (US) is used because it is located deep under the muscles, and hence the nerve is not always visible. Blocking the nerve in the supraclavicular region, where it passes underneath the omohyoid muscle, could be an attractive alternative. ⋯ Visualization of the SSN with US is better in the supraclavicular region as compared with the supraspinous fossa. The anatomic dissections confirmed that our novel supraclavicular SSN block technique is accurate.
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Reg Anesth Pain Med · May 2012
Randomized Controlled Trial Comparative StudyRandomized controlled trial comparing pudendal nerve block under ultrasound and fluoroscopic guidance.
Although fluoroscopy is an established imaging modality for pudendal nerve block, ultrasound (US) technique allows physicians better visualization of anatomic structures. This study aimed to compare the effectiveness and safety between the US- and fluoroscopy-guided techniques. ⋯ Ultrasound-guided pudendal nerve blockade is as accurate as fluoroscopically guided injections when performed by an experienced clinician. However, the former took a longer time to perform.