Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2009
Multicenter StudyVarious possible positions of conventional catheters around the femoral nerve revealed by neurostimulation.
In continuous femoral nerve blocks, the various perineural positions of the tip of a conventional catheter and their clinical implication are not completely known.We used stimulating catheters to explore the relationship of catheter tip to nerve. ⋯ The effectiveness of a continuous femoral block depends on neurostimulation characteristics, which likely correspond to various possible catheter tip positions. Conventional catheters provide no information on this issue. These results suggest that better VAS scores are attainable by placing catheters with neurostimulation guidance.
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Reg Anesth Pain Med · May 2009
Multicenter StudyOutcome predictors for sacroiliac joint (lateral branch) radiofrequency denervation.
Sacroiliac (SI) joint pain is a challenging condition characterized by limited treatment options. Recently, numerous studies have reported excellent intermediate-term outcomes after lateral-branch radiofrequency (RF) denervation, but these studies are characterized by wide variability in technique, selection criteria, and patient characteristics. The purpose of this study was to determine whether any demographic or clinical variables can be used to predict SI joint RF denervation outcome. ⋯ Whereas several factors were found to influence outcome, no single clinical variable reliably predicted treatment results. The use of more stringent selection criteria was not associated with better outcomes.
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Reg Anesth Pain Med · Nov 2008
Randomized Controlled Trial Multicenter StudyEffects of local anesthetic concentration and dose on continuous interscalene nerve blocks: a dual-center, randomized, observer-masked, controlled study.
It is currently unknown if the primary determinant of continuous peripheral nerve block effects is simply total drug dose, or whether local anesthetic concentration and/or volume have an influence. We therefore tested the null hypothesis that providing ropivacaine at different concentrations and rates--but at an equal total basal dose--produces similar effects when used in a continuous interscalene nerve block. ⋯ For continuous interscalene nerve blocks, given the statistically inconclusive primary endpoint results and design limitations of the current study, further research on this topic is warranted. In contrast, providing a lower concentration of local anesthetic at a higher basal rate provided superior analgesia.
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Reg Anesth Pain Med · Sep 2008
Multicenter Study Comparative StudyComplications associated with eye blocks and peripheral nerve blocks: an american society of anesthesiologists closed claims analysis.
Concern for block-related injury and liability has dissuaded many anesthesiologists from using regional anesthesia for eye and extremity surgery, despite many studies demonstrating the benefits of regional over general anesthesia. To determine injury patterns and liability associated with eye and peripheral nerve blocks, we re-examined the American Society of Anesthesiologists Closed Claims Database as part of the American Society of Regional Anesthesia and Pain Medicine's Practice Advisory on Neurologic Complications of Regional Anesthesia and Pain Medicine. ⋯ Performance of eye blocks by anesthesiologists significantly alters their liability profile, primarily related to permanent eye damage from block needle trauma. Though most peripheral nerve block claims are associated with temporary injuries, local anesthetic toxicity is a major cause of death or brain damage in these claims.