Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2013
Analysis of Inadvertent Intradiscal and Intravascular Injection During Lumbar Transforaminal Epidural Steroid Injections: A Prospective Study.
Inadvertent intradiscal injection during a lumbar transforaminal epidural steroid injection (TFESI) can be critical given the possibility of discitis and disc degeneration. Intravascular steroid injection can result in devastating neurologic complications. We sought to identify the incidence of intradiscal and intravascular injection during lumbar TFESI and determine whether an aspiration test and static fluoroscopic image can be used to predict intravascular needle placement. ⋯ Inadvertent intradiscal injection during TFESI is not rare. Physicians who perform interventional pain procedures should increase their awareness of related potential complications. The aspiration test and static image of fluoroscope often fail to detect the intravascular injection during the TFESI. Real-time fluoroscopy should be the gold standard for confirming intravascular injection.
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Reg Anesth Pain Med · Nov 2013
Randomized Controlled Trial Comparative StudyAdductor Canal Block Versus Femoral Nerve Block for Analgesia After Total Knee Arthroplasty: A Randomized, Double-blind Study.
Quadriceps strength is better preserved after adductor canal block for total knee arthroplasty than femoral nerve block with similar analgesic effect.
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Reg Anesth Pain Med · Nov 2013
Randomized Controlled Trial Comparative StudyA Dose-Ranging Study of 0.5% Bupivacaine or Ropivacaine on the Success and Duration of the Ultrasound-Guided, Nerve-Stimulator-Assisted Sciatic Nerve Block: A Double-Blind, Randomized Clinical Trial.
Before bifurcation, the sciatic nerve is composed of 2 component nerves encased in a common investing extraneural layer (CIEL). We examined the effect of various volumes injected beneath the CIEL on the success and duration of sciatic nerve block. ⋯ Injecting 10 mL of 0.5% bupivacaine or ropivacaine below the CIEL produces comparable onset and duration of sensory and motor blockade as volumes as large as 30 mL.
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Reg Anesth Pain Med · Nov 2013
Observational StudyAn Analysis of the Safety of Epidural and Spinal Neuraxial Anesthesia in More Than 100,000 Consecutive Major Lower Extremity Joint Replacements.
A feared complication of spinal or epidural anesthesia is the development of epidural or spinal hematoma with subsequent neural element compression. Most available data are derived from the obstetric literature. Little is known about the frequency of hematoma occurrence among patients undergoing orthopedic joint arthroplasty, who are usually elderly and experience significant comorbidities. We sought to study the incidence of clinically significant lesions after spinal and epidural anesthesia and further describe their nature. ⋯ The incidence of epidural/spinal complications found in this consecutive case series is relatively low but higher than previously reported in the nonobstetric population. Further research using large data sets could quantify the significance of some of the potentially contributing factors observed in this study.