Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2014
Randomized Controlled TrialEfficacy of Ketamine as an Adjunct to Lidocaine in Intravenous Regional Anesthesia.
The addition of ketamine to lignocaine-based IVRA (Bier's block) significantly improved analgesia and patient satisfaction without increasing side effects.
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Reg Anesth Pain Med · Sep 2014
Randomized Controlled TrialPreoperative Fascia Iliaca Compartment Block for Positioning Patients With Hip Fractures for Central Nervous Blockade: A Randomized Trial.
Appropriate pain management may positively affect outcome following hip fractures. Positioning patients for spinal anesthesia (SA) can be extremely painful. Peripheral nerve blockades are gaining popularity in this setting. This prospective, randomized study compares the efficacy of fascia iliaca compartment block (FICB) to intravenous (IV) fentanyl for positioning hip fracture patients for SA. ⋯ Performing an FICB before positioning for SA provides superior pain management compared with IVFE administration, facilitates spinal performance, and yields satisfactory postoperative analgesia and wide patient acceptance, hence improving overall quality and efficiency of care.
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Reg Anesth Pain Med · Sep 2014
Intraneural or Extraneural: Diagnostic Accuracy of Ultrasound Assessment for Localizing Low-Volume Injection.
When one is performing ultrasound-guided peripheral nerve blocks, it is common to inject a small amount of fluid to confirm correct placement of the needle tip. If an intraneural needle tip position is detected, the needle can then be repositioned to prevent injection of a large amount of local anesthetic into the nerve. However, it is unknown if anesthesiologists can accurately discriminate intraneural and extraneural injection of small volumes. Therefore, this study was conducted to determine the diagnostic accuracy of ultrasound assessment using a criterion standard and to compare experts and novices in ultrasound-guided regional anesthesia. ⋯ Discrimination of intraneural or extraneural needle tip position based on an injection of 0.5mL is possible, but even experts missed 1 of 6 intraneural injections. In novices, the sensitivity of assessment was significantly lower, highlighting the need for focused education.
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Reg Anesth Pain Med · Sep 2014
Comparative StudyRegional Anesthesia, Time to Hospital Discharge, and In-Hospital Mortality: A Propensity Score Matched Analysis.
The anesthetic technique used during surgery can affect postoperative length of stay and outcomes, even after controlling for other clinically important factors. This study evaluated the impact of regional anesthesia (RA) compared with general anesthesia (GA) on the amount of time between leaving the operating room and hospital discharge and the odds of in-hospital mortality. ⋯ The study data provide evidence that median time to discharge is shorter when RA is used instead of GA, controlling for other clinically important factors. Additionally, RA use during surgery was associated with a decrease in in-hospital mortality. When an appropriate option, RA may facilitate faster hospital discharge and improve patient outcomes.
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Reg Anesth Pain Med · Sep 2014
Comparative StudyAccuracy and consistency of modern elastomeric pumps.
Continuous peripheral nerve blockade has become a popular method of achieving postoperative analgesia for many surgical procedures. The safety and reliability of infusion pumps are dependent on their flow rate accuracy and consistency. ⋯ Several studies have investigated the accuracy of portable infusion pumps. Using methodology similar to that used by Ilfeld et al, we investigated the accuracy and consistency of several current elastomeric pumps.