Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2020
Postdural puncture headache in the obstetric population: a new approach?
The gold standard for the treatment of postdural puncture headache (PDPH) is the epidural blood patch (EBP). Regional techniques-sphenopalatine ganglion block (SPGB), greater occipital nerve block (GONB) and trigger point infiltration (TPI)-can also be used for the treatment of PDPH. Our objective was to evaluate the efficacy of these peripheral nerve blocks (PNBs) in the treatment of PDPH. ⋯ SPGB, GONB and TPI can be safe and effective options for treatment of PDPH, but do not completely eliminate the need for EBP. Prospective studies designed to identify factors associated with unsuccessful treatment are required.
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Reg Anesth Pain Med · May 2020
Observational StudyAnalysis of judicial precedent cases regarding epidural injection in chronic pain management in Republic of Korea.
Although there is a low incidence of complications associated with epidural injections, pain physicians should still remain vigilant for potentially serious adverse outcomes. This study aimed to identify and describe the major complications of epidural injections. ⋯ Our data will allow pain physicians to become acquainted with the major epidural injection-associated complications that underlie malpractice cases.
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Reg Anesth Pain Med · May 2020
Intertruncal approach to the supraclavicular brachial plexus, current controversies and technical update: a daring discourse.
We propose a new approach to local anesthetic injection for the supraclavicular brachial plexus block: an intertruncal approach by which local anesthetic is deposited in the two adipose tissue planes between the upper and middle and the middle and lower trunks. We present sonographic and microscopic images to illustrate the relevant anatomy. ⋯ It also offers an advantage over the 'intracluster' approach as it purposefully avoids intraneural injection respecting the integrity of the epineurium of individual trunks. Comparative studies are required to confirm that these anatomic and technical advantages result in improved outcomes.
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Reg Anesth Pain Med · May 2020
Microbiological and scanning electron microscopic evaluation of epidural catheters.
Epidural catheters are frequently colonized by gram-positive bacteria. Although the incidence of associated epidural infections is low, their consequences can be devastating. We investigated bacterial growth on epidural catheters by quantitative bacterial culture and scanning electron microscopy (SEM) in order to explore the patterns of epidural catheter colonization. ⋯ We present the first SEM pictures of an epidural catheter with a bacterial infection. Bacterial growth developed from the skin to the tip of this catheter, indicating the skin as a primary source of infection. By SEM, catheters with low levels of bacterial growth demonstrated an intraluminal fibrous network which possibly plays a role in catheter obstruction.