Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2016
ReviewEvidence Basis for Ultrasound-Guided Block Characteristics Onset, Quality, and Duration.
This systematic review summarizes existing evidence for superior onset, quality, and duration of block for ultrasound guidance versus other techniques for nerve localization. MEDLINE was systematically searched from 1966 to June 2013 for randomized controlled trials (RCTs) comparing ultrasound guidance to another technique for peripheral nerve blocks. Twenty-three RCTs were identified for upper-extremity peripheral nerve blocks and 17 for lower extremity. ⋯ One RCT reported that ultrasound was inferior for quality and duration for ankle block. There is level 1b evidence to make a grade A recommendation that ultrasound guidance provides a modest improvement in block onset and quality of peripheral nerve blocks, especially for lower extremity. Ultrasound is rarely inferior to other techniques.
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Reg Anesth Pain Med · Mar 2016
Meta AnalysisUltrasound-Guided Regional Anesthesia and Patient Safety: Update of an Evidence-Based Analysis.
In 2010, the American Society of Regional Anesthesia and Pain Medicine's evidence-based medicine assessment of ultrasound (US)-guided regional anesthesia (UGRA) analyzed the effect of this nerve localization technology on patient safety. That analysis focused on 4 important regional anesthesia complications: peripheral nerve injury, local anesthetic systemic toxicity (LAST), hemidiaphragmatic paresis (HDP), and pneumothorax. In the intervening 5 years, further research has allowed us to refine our original conclusions. ⋯ Conversely, emerging evidence supports the effectiveness of US guidance for reducing LAST across its clinical presentation continuum. The predicted frequency of pneumothorax has grown smaller in tandem with increased experience with US-guided supraclavicular block. This evidence-based review summarizes both the power and the limitations of UGRA as a tool for improving patient safety.
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Reg Anesth Pain Med · Mar 2016
Review Case ReportsCombined Fascia Iliaca and Sciatic Nerve Block for Hip Surgery in the Presence of Severe Ankylosing Spondylitis: A Case-Based Literature Review.
Selecting an appropriate anesthetic technique for patients with ankylosing spondylitis undergoing hip surgery is challenging because of a potentially difficult airway, the risk of cardiovascular and respiratory complications, and the technical difficulty of performing central neuraxial blocks in patients with ankylosing spondylitis. Our objective was to report a case in which combination neural blockade was used successfully in an elderly patient with ankylosing spondylitis undergoing hip fracture surgery. In addition, a literature review of the anesthetic techniques reported for these patients was conducted. ⋯ According to the literature review, general anesthesia is the most commonly performed anesthetic technique for patients with ankylosing spondylitis undergoing hip surgeries. Special intubation techniques and cautious airway management were very important for these patients. Although both general anesthesia and central neuraxial blockade pose considerable risks to the patients, this case report suggests that combined fascia iliaca block and sciatic nerve block might be a promising option.
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Reg Anesth Pain Med · Mar 2016
ReviewEvidence Base for the Use of Ultrasound for Upper Extremity Blocks: 2014 Update.
This article reviews and summarizes randomized, controlled studies that have assessed ultrasound (US) guidance for brachial plexus blocks in comparison with other nerve localization methods as well as those that have compared different US-guided brachial plexus block techniques. Both PubMed and EMBASE databases were searched using the MeSH terms anesthetic technique, brachial plexus, and ultrasound. Studies were included if they had randomized allocation comparing US with another conventional nerve localization technique or if they compared 2 different US-guided techniques, such as single versus multiple injections. ⋯ These were compared with χ analysis with the null hypothesis that US provides no benefit for brachial plexus blocks. Forty-seven studies met the inclusion criteria, and 29 compared US guidance to landmark or peripheral nerve stimulation techniques. Our analysis of the literature supports the use of US over other nerve localization techniques as being beneficial for several block performance outcomes including block performance time, reducing the number of needle passes and the incidence of vascular puncture, shortening sensory block onset time, and improving block success.