Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2020
Observational StudyHigh definition ultrasound imaging of the individual elements of the brachial plexus above the clavicle.
Ultrasonography of the brachial plexus (BP) has been described but there are limited data on visualization of the T1 ventral ramus and the inferior trunk. This prospective observational study aimed to evaluate a high definition ultrasound imaging technique to systematically identify the individual elements of the BP above the clavicle. ⋯ We have demonstrated that it is feasible to accurately identify majority of the main components of the BP above the clavicle, including the T1 ventral ramus and the formation of the inferior trunk, using high definition ultrasound imaging.
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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.
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Reg Anesth Pain Med · May 2020
HYR-PB21-LA, a potential extended-release bupivacaine formulation, produces long-lasting local anesthesia in rats and guinea pigs.
Effective postoperative pain management plays a key role in enhancing recovery of patients after surgery. Bupivacaine hydrochloride is one of the most commonly local anesthetics used for the postoperative pain control. However, the relatively short anesthesia duration of bupivacaine preparations limited their clinical application. ⋯ The results demonstrated that the HYR-PB21-LA produced longer local anesthesia effect than current clinical preparations of bupivacaine in two animal models. These findings raise the potential clinical value of HYR-PB21-LA as a long-lasting local anesthesia for controlling postsurgical pain in humans.