Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2013
The myth of the equiangular triangle for identification of sacral hiatus in children disproved by ultrasonography.
A triangle formed by the sacral hiatus and posterior superior iliac spines (PSISs) has been known as equiangular and has been proposed as a way to help identify the sacral hiatus for a caudal block. In children, however, no feasibility study of this triangle has been performed. We compared the expected sacral hiatus obtained from the equiangular triangle method and the real sacral hiatus confirmed by ultrasound. ⋯ In children, using the equiangular triangle to identify the sacral hiatus may be inappropriate because the actual triangle formed by the sacral hiatus and PSISs is not equiangular.
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Reg Anesth Pain Med · May 2013
Randomized Controlled Trial Comparative StudyA randomized comparison between ultrasound- and fluoroscopy-guided third occipital nerve block.
Third occipital nerve block (TONB) is commonly used in the diagnosis and treatment of upper neck pain and cervicogenic headaches. Although fluoroscopy is the current imaging standard for TONB, ultrasound (US) guidance offers a promising, radiation-free alternative. In this randomized, observer-blinded trial, we compared the 2 imaging modalities. Our research hypothesis was that US guidance would result in a shorter performance time. ⋯ Fluoroscopy and US guidance provide similar success rates for TONB. However, ultrasonography is associated with improved efficiency (decreased performance time, fewer needle passes).
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Reg Anesth Pain Med · May 2013
Randomized Controlled TrialA randomized comparison between 3 combinations of volume and concentration of lidocaine for ultrasound-guided infraclavicular block.
This prospective, randomized, observer-blinded study compared 3 combinations of volume and concentration using the same total dose of lidocaine for ultrasound-guided infraclavicular block. ⋯ Using an identical dose (525 mg) of adrenalized lidocaine for ultrasound-guided infraclavicular block, we found no differences in onset time among 3 commonly used concentrations (1%, 1.5%, and 2%). Further studies are required to determine the optimal combination of volume and concentration of lidocaine for other ultrasound-guided approaches to the brachial plexus.