Regional anesthesia and pain medicine
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The precise location of the adductor canal remains controversial among anesthesiologists. In numerous studies of the analgesic effect of the so-called adductor canal block for total knee arthroplasty, the needle insertion point has been the midpoint of the thigh, determined as the midpoint between the anterior superior iliac spine and base of patella. "Adductor canal block" may be a misnomer for an approach that is actually an injection into the femoral triangle, a "femoral triangle block." This block probably has a different analgesic effect compared with an injection into the adductor canal. We sought to determine the exact location of the adductor canal using ultrasound and relate it to the midpoint of the thigh. ⋯ In all volunteers, the midpoint of the thigh was proximal to the beginning of the adductor canal, suggesting that an injection performed at this level is in fact a femoral triangle block.
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Reg Anesth Pain Med · Mar 2017
Randomized Controlled TrialEffect of Perineural Dexamethasone on the Duration of Single Injection Saphenous Nerve Block for Analgesia After Major Ankle Surgery: A Randomized, Controlled Study.
Patients undergoing major elective ankle surgery often experience pain from the saphenous nerve territory persisting beyond the duration of a single-injection saphenous nerve block. We hypothesized that perineural dexamethasone as an adjuvant for the saphenous nerve block prolongs the duration of analgesia and postpones as well as reduces opioid-requiring pain. ⋯ Perineural dexamethasone as an adjuvant for the single-injection subsartorial saphenous nerve block can prolong analgesia and reduce opioid-requiring pain after major ankle surgery.
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Reg Anesth Pain Med · Mar 2017
Ultrasound-Guided Costoclavicular Brachial Plexus Block: Sonoanatomy, Technique, and Block Dynamics.
This study aimed to describe in detail the relevant sonoanatomy, technique, and block dynamics of an ultrasound-guided costoclavicular brachial plexus block (BPB). ⋯ This report describes a novel technique of infraclavicular BPB at the costoclavicular space that produces rapid onset of BPB. Future research should compare the safety and efficacy of this new technique with the traditional lateral sagittal infraclavicular BPB.
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Reg Anesth Pain Med · Mar 2017
Review Meta AnalysisInvestigating the Efficacy of Dexmedetomidine as an Adjuvant to Local Anesthesia in Brachial Plexus Block: A Systematic Review and Meta-Analysis of 18 Randomized Controlled Trials.
Dexmedetomidine has been thought to be an effective adjuvant to local anesthetics in brachial plexus blockade. We sought to clarify the uncertainty that still exists as to its true efficacy. ⋯ Therapeutic, level I.