Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2015
Case ReportsManagement of a Rare Complication of Epidural Analgesia in an Obese Laterally Positioned Parturient: Catheter Entrapment Next to the Inferior Vena Cava.
Intravascular, subdural, intrathecal, and subcutaneous placement of epidural catheters are known complications and common causes of anesthesia and analgesia failure. Because the epidural space is located near the retroperitoneum and catheters are placed blindly, it is possible that misplacement could involve other structures, including the inferior vena cava, the aorta, and the lumbar plexus. We report a case of an obese laterally positioned parturient who presented with an epidural catheter lodged in the retroperitoneum. ⋯ Conventional removal techniques were unsuccessful, and the catheter was finally removed after insertion of a guide wire under fluoroscopy. We conclude that obesity and lateral positioning are factors that increase the risk of epidural catheter misplacement, and a large distance from skin to loss of resistance is a potential sign of misplacement. We recommend ultrasound imaging to aid in the insertion of epidural catheters in high-risk patients.
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Reg Anesth Pain Med · Nov 2015
Ultrasound-Guided Approach for L5 Dorsal Ramus Block and Fluoroscopic Evaluation in Unpreselected Cadavers.
Medial branch blocks are frequently performed to diagnose lumbar facet-joint-mediated pain. Ultrasound guidance can increase practicability and eliminate exposure to ionizing radiation when compared with fluoroscopy. However, ultrasound-guided L5 dorsal ramus block, which, together with L4 medial branch block is necessary to anesthetize the most commonly affected facet joint L5/S1, has not been described so far. The objective of this study was to develop a technique and to evaluate its accuracy with standard fluoroscopy in unpreselected cadavers. ⋯ This is the first study to show that ultrasound-guided L5 dorsal ramus block is accurate and feasible in the absence of significant spondylolisthesis when performed with an oblique out-of-plane technique.
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Reg Anesth Pain Med · Nov 2015
Case ReportsSpinal Anesthesia in a Patient With a History of Systemic Capillary Leak Syndrome (Clarkson Disease).
The aim of this study was to review the relative risks, benefits, and anesthetic considerations of neuraxial, regional, and general anesthesia in a patient with known systemic capillary leak syndrome (SCLS) who presents for elective total knee replacement. ⋯ Spinal anesthesia constitutes a viable option for a patient with a history of SCLS in sustained remission. It remains unclear whether general or neuraxial anesthesia confers the best risk-to-benefit ratio for such patients.