Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2012
Randomized Controlled TrialPersistent median artery (palmar type) and median nerve block in the forearm: observational study of prevalence.
We sought to define the crude prevalence rate of the persistent median artery (PMA) (palmar type). Although there is no reported case in the anesthetic literature, a few sporadic case reports and series reported in anatomical and orthopedic journals describe an incidence of between 1.5% and 27.1%. ⋯ Anatomical variations of the blood supply to the forearm and hand can be identified with available high-frequency ultrasound equipment. Arterial variants immediately adjacent to the median nerve may occur in approximately 1 in 5 limbs. Practitioners should actively seek their presence or absence.
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Reg Anesth Pain Med · Sep 2012
Perioperative nerve injury after total shoulder arthroplasty: assessment of risk after regional anesthesia.
One of the most debilitating complications after total shoulder arthroplasty (TSA) is perioperative nerve injury (PNI). Interscalene blockade (ISB) improves clinical outcomes after TSA, but it may increase the risk for PNI. The objective of this large-scale, single-institution cohort study was to test the hypothesis that the use of ISB increases the risk for PNI after elective TSA. ⋯ The incidence of PNI (2.2%) is consistent with previous estimates in patients undergoing TSA. The use of ISB did not increase the risk for PNI. Most patients with PNI had improvement of their neurologic symptoms. These results further support the use of ISB analgesia for patients undergoing TSA.
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Reg Anesth Pain Med · Sep 2012
Ultrasound-guided ankle block for forefoot surgery: the contribution of the saphenous nerve.
Ankle blocks typically include the block of 5 nerves, the 4 branches that trace their origin back to the sciatic nerve plus the saphenous nerve (SaN). The sensory area of the SaN in the foot is variable. Based on our clinical experience, we decided to study the sensory distribution of the SaN in the foot and determine whether the block of this nerve is necessary as a component of an ultrasound-guided ankle block for bunion surgery. ⋯ Ultrasound-guided ankle block is a highly effective technique for bunion surgery. The sensory territory of the SaN in the foot seems to extend only to the midfoot. According to our sample, 97% of the patients undergoing bunion surgery under an ankle block would not benefit from having a SaN block.
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Reg Anesth Pain Med · Sep 2012
Intrathecal oxytocin inhibits visceromotor reflex and spinal neuronal responses to noxious distention of the rat urinary bladder.
Oxytocin (OXY) is a neuropeptide that has recently been recognized as an important component of descending analgesic systems. The present study sought to determine if OXY produces antinociception to noxious visceral stimulation. ⋯ These results argue that intrathecal OXY produces an OXY receptor-specific antinociception to noxious UBD, with part of this effect due to inhibition of spinal dorsal horn neurons. To our knowledge, these studies provide the first evidence that intrathecal OXY may be an effective pharmacological treatment for visceral pain.