Regional anesthesia and pain medicine
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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 for the Use of Ultrasound Imaging in Pediatric Regional Anesthesia: A Systematic Review.
An earlier review to evaluate the quality and outcomes of studies assessing ultrasound imaging in regional anesthesia for the pediatric population considered articles published from 1994 to 2009 and showed some evidence in support of block-related outcomes (block onset, success, duration) and process-related outcomes (performance time, local anesthetic dose, and spread). At that time, strong evidence in the form of randomized controlled trials and well-designed prospective observational studies was limited, leading to a call for additional research. ⋯ Using the MEDLINE and EMBASE databases, we included in this review studies examining ultrasound imaging for nerve localization in the pediatric population between 2009 and March 2014 (meta-analyses, systematic reviews, randomized controlled trials, controlled studies without randomization, observational studies, comparative studies, and case series involving at least 10 patients). In the current review, we identified 24 and 13 articles evaluating peripheral nerve blocks and neuraxial anesthesia, respectively.
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Reg Anesth Pain Med · Mar 2016
ReviewUpdate on Ultrasound for Truncal Blocks: A Review of the Evidence.
We summarized the evidence for ultrasound (US) guidance for truncal blocks in 2010 by performing a systematic literature review and rating the strength of evidence for each block using a system developed by the United States Agency for Health Care Policy and Research. Since then, numerous studies of US guidance for truncal blocks have been published. ⋯ To provide updated recommendations, we performed another systematic search of the literature to identify studies pertaining to US guidance for the following blocks: paravertebral, intercostal, transversus abdominis plane, rectus sheath, ilioinguinal/iliohypogastric, as well as the Pecs, quadratus lumborum, and transversalis fascia blocks. We rated the methodologic quality of each of the identified studies and then graded the strength of evidence supporting the use of US for each block based on the number and quality of available studies for that block.
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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.
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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.