Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2012
Incidence of local anesthetic systemic toxicity and postoperative neurologic symptoms associated with 12,668 ultrasound-guided nerve blocks: an analysis from a prospective clinical registry.
There are varying reports on the incidence of major morbidity associated with peripheral regional anesthesia. Our objective was to contribute to the knowledge regarding the incidence of local anesthetic systemic toxicity and postoperative neurologic symptoms in the setting of ultrasound-guided peripheral regional anesthesia. ⋯ In the setting of a surgical procedure, ultrasound-guided regional anesthesia is associated with the risk of long-term postoperative neurologic symptoms. Local anesthetic systemic toxicity, however, is extremely uncommon.
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Reg Anesth Pain Med · Sep 2012
Randomized Controlled Trial Clinical TrialUltrasound-guided nerve block for inguinal hernia repair: a randomized, controlled, double-blind study.
Open inguinal hernia repair in adults is considered a minor surgical procedure but can be associated with significant pain. We aimed to evaluate acute postoperative pain management in male adults randomized to receive an ultrasound-guided ilioinguinal and iliohypogastric nerve block administered before surgery, in addition to a standard analgesic regimen. ⋯ Ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerves resulted in a statistically significant and clinically relevant reduction in postoperative pain in the PACU both at mobilization and at rest.
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Reg Anesth Pain Med · Sep 2012
Randomized Controlled Trial Comparative StudyA prospective, randomized comparison between perivascular and perineural ultrasound-guided axillary brachial plexus block.
This prospective, randomized, observer-blinded study compared perivascular (PV) and perineural (PN) ultrasound-guided axillary brachial plexus block (AXB) for upper extremity surgery. ⋯ Perivascular and PN ultrasound-guided AXBs result in comparable success rates and total anesthesia-related times. Because of fewer needle passes and a shorter performance time, the PV technique provides a simple alternative for ultrasound-guided AXB.
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Reg Anesth Pain Med · Sep 2012
Randomized Controlled TrialRandomized study of the effect of local anesthetic volume and concentration on the duration of peripheral nerve blockade.
Ultrasound guidance reduces the required local anesthetic volume for successful peripheral nerve block, but it is unclear whether this influences block duration. We investigated the ropivacaine volume and concentration effect on interscalene block duration. ⋯ Block duration is influenced by both local anesthetic volume and concentration, a finding of increasing relevance with the current trend to lower volumes for ultrasound-guided regional anesthesia.
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Reg Anesth Pain Med · Sep 2012
Brachial plexus root injection in a human cadaver model: injectate distribution and effects on the neuraxis.
The potential for injection into the brachial plexus root at cervical levels must be considered during interscalene block or chronic pain interventions in the neck, but this phenomenon has not been well studied. In this investigation, we performed injections into the brachial plexus roots of unembalmed cadavers, with real-time ultrasound guidance, to evaluate the proximal and distal spread of the injected fluids, the potential of the injectate to reach the neuraxis, and whether the injectate could migrate into the actual substance of the spinal cord itself. ⋯ Injection directly into the neural tissue of a brachial plexus root in a cadaver model produced high pressures suggestive of intrafascicular injection and widespread flow of the injectate through the distal brachial plexus. However, proximal movement of the dye-containing injectate was more restricted, with only 1 of the injections leading to epidural spread and no apparent effects on the spinal cord.