Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Aug 2018
Real-Time Ultrasound-Assisted Thoracic Epidural Placement: A Feasibility Study of a Novel Technique.
The placement of thoracic epidural catheters is complicated by the layering of the vertebral lamina. Therefore, traditional blind palpation techniques require insertion of an epidural needle with likely contact of lamina with redirections into the epidural space. ⋯ Successful epidural placement was achieved in every patient. All catheters were found to be effective for use in the postoperative phase.
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Reg Anesth Pain Med · Aug 2018
Randomized Controlled Trial Comparative StudyA Randomized Comparison Between Interscalene and Small-Volume Supraclavicular Blocks for Arthroscopic Shoulder Surgery.
This randomized trial compared ultrasound (US)-guided interscalene block (ISB) and small-volume supraclavicular block (SCB) for arthroscopic shoulder surgery. We hypothesized that SCB would provide equivalent analgesia to ISB 30 minutes after surgery without the risk of hemidiaphragmatic paralysis (HDP). ⋯ This study was registered at ClinicalTrials.gov, identifier NCT03224884.
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Reg Anesth Pain Med · Aug 2018
Ultrasound Assessment of Ice-Ball Formation by Cryoneurolysis Device in an Ex Vivo Model.
Real-time ice-ball formation during cryoneurolysis has sparsely been assessed with ultrasound (US). Cryoneurolysis in lower back pain syndrome represents a validated management option in cases of facet joint syndrome. Ultrasound may be a useful tool to perform facet joint cryodenervation. The objective of this study was to assess, ex vivo, the ability of US to assess the ice-ball formation of a cryoneurolysis device. ⋯ Ultrasound is a useful tool to monitor the formation of ice ball during a cryoneurolysis freezing cycle. Power Doppler appears as the only option to monitor the ice ball with low-frequency transducers. This novel finding may be useful in cases of lumbar medial branch cryoneurolysis, an application we plan to assess in a future pilot prospective study.
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Reg Anesth Pain Med · Aug 2018
Case ReportsMajor Laparoscopic Intraperitoneal Surgery Performed With Combined Bilateral Subcostal Transversus Abdominal Plane Block and Celiac Plexus Block, Intravenous Sedation Without Tracheal Intubation: A Feasibility Study of 3 Cases.
Major abdominal surgery usually requires general anesthesia with tracheal intubation and may be supplemented with neuraxial anesthesia to provide intraoperative and postoperative pain relief. Attempts at using only neuraxial anesthesia for major abdominal surgery have often been shown to be poorly effective. This report demonstrates that laparoscopic colonic surgical procedures can be performed with ultrasound-guided blocks (bilateral transversus abdominal plane block and celiac plexus block) and intravenous sedation, while avoiding general or neuraxial anesthesia. ⋯ To date, celiac plexus block has been used almost exclusively to relieve pancreatic cancer pain. This is the first report in which it is shown that major intra-abdominal surgery can be performed almost exclusively with regional anesthesia while avoiding adverse effects and problems associated with either general or neuraxial anesthesia. In addition, prolonged postoperative pain relief facilitated early recovery.
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Reg Anesth Pain Med · Aug 2018
A Cadaveric Study Investigating the Mechanism of Action of Erector Spinae Blockade.
Erector spinae block is an ultrasound-guided interfascial plane block first described in 2016. The objectives of this cadaveric dye injection and dissection study were to simulate an erector spinae block to determine if dye would spread anteriorly to the involve origins of the ventral and dorsal branches of the spinal nerves. ⋯ There was no spread of dye anteriorly to the paravertebral space to involve origins of the ventral and dorsal branches of the thoracic spinal nerves. Dorsal ramus involvement was posterior to the costotransverse foramen.