Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Jan 2019
Case ReportsPatients with a history of hypersensitivity reaction to iodinated contrast medium and given iodinated contrast during an interventional pain procedure.
In patients with a history of a hypersensitivity reaction to iodinated contrast medium, iodinated contrast medium is avoided, antihistamine and steroid premedication are given, or a gadolinium-based contrast agent is employed. Six patients with a history of a hypersensitivity reaction to iodinated contrast medium and who were not premedicated had an unintentional injection of iodinated contrast. None of the patients developed a moderate or severe reaction. ⋯ The lack of a significant reaction may be due to any or all of the following: questionable history of iodinated contrast reaction, low dose of iodinated contrast given, concomitant injection of (epidural) steroid, and slower absorption from epidural compared with intravenous injection. While it is reassuring to know that there is a low possibility of a moderate to severe reaction in these patients, every effort should be made to avoid this scenario, appropriate drugs and resuscitation equipment should be immediately available, and the patients should be observed adequately and followed for the possibility of late reactions. Recent publications have called for caution in the use of gadolinium-based contrast agents.
-
Reg Anesth Pain Med · Jan 2019
Evaluation of the B-Smart manometer and the CompuFlo computerized injection pump technology for accurate needle-tip injection pressure measurement during peripheral nerve blockade.
The exact mechanism of peripheral nerve blocks causing/leading to nerve injury remains controversial. Evidence from animal experiments suggests that intrafascicular injection resulting in high injection pressure has the potential to rupture nerve fascicles and may consequently cause permanent nerve injury and neurological deficits. The B-Smart (BS) in-line manometer and the CompuFlo (CF) computerized injection pump technology are two modalities used for monitoring pressure during regional anesthesia. This study sought to explore the accuracy of these two technologies in measuring needle-tip pressures in a simulated environment. ⋯ Future research is needed to explore in-vivo performance and evaluate whether either of these devices can impact on clinical outcomes.
-
Reg Anesth Pain Med · Jan 2019
"Pseudo-suprascapular notch": is it a sonographic trap in suprascapular nerve block?
The aim of the study was to describe the radiological anatomy of the pseudo-suprascapular notch-a structure localized at the floor of the supraspinatus fossa, just below the true suprascapular notch. In sonographic examination, it may imitate the suprascapular notch leading to misidentification of these structures. ⋯ The pseudo-suprascapular notch is a hollow for nutrient vessels that can be mistaken for the regular suprascapular notch in cases of difficult sonographic navigation.
-
Reg Anesth Pain Med · Jan 2019
Long-term efficacy of 1-1.2 kHz subthreshold spinal cord stimulation following failed traditional spinal cord stimulation: a retrospective case series.
We investigated whether an effective long-term pain relief could be achieved using subthreshold 1-1.2 kHz spinal cord stimulation (SCS) among patients who were initially implanted with traditional paresthesia-based SCS but who failed to maintain an adequate pain relief. ⋯ The results from our single center failed to show additional long-term clinical benefit of 1-1.2 kHz subthreshold SCS in patients with chronic pain failing traditional low-frequency SCS.