Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2018
Randomized Controlled TrialLocal Anesthetic Injection Speed and Common Peroneal Nerve Block Duration: A Randomized Controlled Trial in Healthy Volunteers.
The speed of local anesthetic (LA) injections in peripheral regional anesthesia ranges from slow continuous infusions (3-12 mL/h) to rapid manual injections (>7500 mL/h). Optimizing injection speed could augment the spread of LA toward the targeted nerves and influence nerve block characteristics. The objective of this study was to investigate whether injection speed of a single dose of LA affects peripheral nerve block duration. ⋯ This study was registered at ClinicalTrials.gov, identifier NCT02801799.
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Reg Anesth Pain Med · Jul 2018
Meta AnalysisThe Impact of Spinal Needle Selection on Postdural Puncture Headache: A Meta-Analysis and Metaregression of Randomized Studies.
Potentially broadened indications for spinal anesthesia require increased understanding of the risk factors and prevention measures associated with postdural puncture headache (PDPH). This review is designed to examine the association between spinal needle characteristics and incidence of PDPH. ⋯ Pencil-point needles are associated with significantly lower incidence of PDPH compared with the cutting-needle design. Whereas a significant relationship was noted between needle gauge and PDPH for cutting-needle design, a similar association was not shown for pencil-point needles. Providers may consider selection of larger-caliber pencil-point needle to maximize technical proficiency without expensing increased rates of PDPH.
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Reg Anesth Pain Med · Jul 2018
Microanatomical Nerve Architecture of 6 Mammalian Species: Is Trans-Species Translational Anatomic Extrapolation Valid?
Various animal models have historically been used to study iatrogenic nerve injury during performance of conduction nerve blocks. Our aims were to compare the microstructures of nerves in commonly used species to those of humans and to explore the validity of the extrapolating these findings to humans. ⋯ Although some of the metrics could reasonably be expected to differ because of the size of the species-for example, nerve cross-sectional area-there was little microanatomical similarity between the sciatic nerves of humans and those of the nonprimate mammalian species studied. This may question the validity of some conclusions reached over the years by direct translation from these species to humans. Further studies on nerve function, intraneural injection, and microanatomy of nonhuman primate species are warranted.