Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Aug 2020
CommentBuprenorphine management: a conundrum for the anesthesiologist and beyond - a one-act play.
We have witnessed a worldwide upsurge of streamlined enhanced recovery after surgery (ERAS) pathways advocating for consistency and compliance within their guidelines. At a recent national conference, two experts defended their institutional policies on perioperative management of buprenorphine, one defending its continuation, while the other suggesting its discontinuation. ⋯ Although the moderator made a valid statement, we demonstrate via our one-act play the importance of recognizing a subset of the population within an ERAS pathway that necessitates multidisciplinary discussion, communication, and patient-centric care to formulate a perioperative plan coordinating a patient's care. More robust research is needed to minimize variability in current practices and to further develop comprehensive evidence-based guidelines that encompass risk factors and anticipated postsurgical and peripartum pain for patients on buprenorphine.
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Reg Anesth Pain Med · Aug 2020
Randomized Controlled TrialUltrasonographic needle tip tracking for in-plane infraclavicular brachialis plexus blocks: a randomized controlled volunteer study.
Onvision is a new technology for needle tip detection and tracking in ultrasound-guided regional anesthesia. The system consists of a piezoelectric sensor close to the needle tip and an electronic console integrated in the ultrasound system. The needle tip is visualized by a green circle on the ultrasound screen. The aim of the study was to investigate the effect of the new needle tip tracking technology on in-plane infraclavicular plexus blocks. ⋯ Our study on needle tip tracking for infraclavicular blocks did not reveal any significant differences between active needle tip tracking and the control procedures, neither for primary outcome nor secondary outcome measurements.
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Reg Anesth Pain Med · Aug 2020
CommentCurrent versus revised anatomical targets for genicular nerve blockade and radiofrequency ablation: evidence from a cadaveric model.
Recent studies have proposed revised anatomical targets to improve accuracy of genicular nerve (GN) radiofrequency ablation (RFA). This study aims to compare the accuracy of classical and revised techniques for fluoroscopic-guided GN-RFA in cadaveric models. ⋯ This study demonstrates that the revised targets are more accurate than the current targets for GN-RFA.
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Reg Anesth Pain Med · Aug 2020
Evaluating the extent of lumbar erector spinae plane block: an anatomical study.
The erector spinae plane (ESP) block is a relatively new interfascial block technique. Previous cadaveric studies have shown extensive cephalocaudal spread with a single ESP injection at the thoracic level. However, little data exist for lumbar ESP block. The objective of this study was to examine the anatomical spread of dye following an ultrasound-guided lumbar ESP block in a human cadaveric model. ⋯ A lumbar ESP injection has limited craniocaudal spread compared with injection in the thoracic region. It has consistent spread to dorsal rami, but no anterior spread to ventral rami or paravertebral space.
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Reg Anesth Pain Med · Aug 2020
Anesthesia residency training in regional anesthesiology and acute pain medicine: a competency-based model curriculum.
The Accreditation Council for Graduate Medical Education has shifted to competency-based medical education. This educational framework requires the description of educational outcomes based on the knowledge, skills and behaviors expected of competent trainees. ⋯ This article describes the development of model curricula for anesthesiology residency training in regional anesthesia and acute pain medicine (core and advanced) using a competency-based framework. We further describe how the curricula were distributed through a shared web-based platform and mobile application.