Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2019
A two-level large-volume epidural blood patch protocol for spontaneous intracranial hypotension: retrospective analysis of risk and benefit.
We report a retrospective analysis of a two-level, variable-volume epidural blood patch (EBP) technique for the treatment of spontaneous intracranial hypotension (SIH). ⋯ Our protocol can be used to treat SIH but carries risks that require meticulous attention. EBP volumes were variable across patients, demonstrating the variability in the elastance of the epidural space. Rigorous monitoring for neurological symptoms is necessary throughout the procedure to limit complications and determine the endpoint of the EBP. We advocate for rigorous confirmation of epidural placement of the EBP with contrast-imaging studies to limit intrathecal placement of blood, which can lead to arachnoiditis. Randomized controlled trials are needed to determine the safety and efficacy of large-volume EBPs.
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Reg Anesth Pain Med · Sep 2019
Management of incidental lumboiliac hernia during spinal cord stimulator implant: a case report.
Lumboiliac or lumbar hernia is a rare defect in the posterolateral abdominal wall that may be inadvertently misidentified and interfere with the implantable pulse generator (IPG) portion of spinal cord stimulator (SCS) implants. We report the case of a 54-year-old Caucasian man with an incidental finding of a lumboiliac hernia in the inferior lumbar triangle of Petit with placement of an IPG in a SCS implant. With the assistance of surgical colleagues, the correct diagnosis was made intraoperatively. ⋯ It is important that pain physicians and neurosurgeons who perform SCS implants are aware of lumboiliac hernias to avoid potential diagnostic or management errors. Lumboiliac hernias should be included on the differential diagnosis of lumbar or flank masses. Confirmation with imaging may be necessary and definitive surgical treatment should be pursued.
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Reg Anesth Pain Med · Sep 2019
Evaluation of suprascapular nerve radiofrequency ablation protocols: 3D cadaveric needle placement study.
Image-guided intervention of the suprascapular nerve is a reported treatment to manage chronic shoulder joint pain. The suprascapular nerve is conventionally targeted at the suprascapular notch; however, targeting of its branches, the medial and lateral trunks, which are given off just posterior to the notch has not been considered. Since the lateral trunk supplies the posterior supraspinatus and articular branches to the glenohumeral joint capsule, while the medial trunk provides motor innervation to the anterior region, it may be possible to preserve some supraspinatus activation if the medial trunk is spared. The main objective was to investigate whether midpoint between suprascapular and spinoglenoid notches is the optimal target to capture articular branches of lateral trunk while sparing medial trunk. ⋯ The findings suggest that the midpoint technique could spare medial trunk of suprascapular nerve, while capturing lateral trunk and articular branches. Further clinical investigation is required.
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Reg Anesth Pain Med · Sep 2019
Survey of regional anesthesiology fellowship directors in the USA on the use of simulation in regional anesthesiology training.
Despite a growing interest in simulated learning, little is known about its use within regional anesthesia training programs. In this study, we aimed to characterise the simulation modalities and limitations of simulation use for US-based resident and fellow training in regional anesthesiology. ⋯ Simulation use for education is common within regional anesthesiology training programs, but rarely used for assessment. Funding and simulator availability are the most common limitations to simulation use.