Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2018
Ultrasound Detection of Arteria Comitans: A Novel Technique to Locate the Sciatic Nerve.
In the gluteal and thigh region, the arteria comitans accompanies the sciatic nerve for a short distance, then penetrates the nerve and runs to the lower part of the thigh. There is no study that recognizes this artery as a guide to the location of the sciatic nerve. In this report, we describe a series of 6 knee arthroplasty patients in whom ultrasound-guided sciatic nerve block was successfully performed using color Doppler and pulsed wave Doppler to visualize the arteria comitans as a guide to the location of the sciatic nerve. We have found that detecting the arteria comitans as a landmark is novel and may offer an additional tool with the existing methods for sciatic nerve block.
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Reg Anesth Pain Med · Jan 2018
Randomized Controlled Trial Comparative StudyComparison of Continuous Proximal Versus Distal Adductor Canal Blocks for Total Knee Arthroplasty: A Randomized, Double-Blind, Noninferiority Trial.
Adductor canal blocks (ACBs) are associated with improved analgesia, preserved quadriceps strength, and decreased length of hospitalization after total knee arthroplasty (TKA). However, controversy remains regarding the ideal location of a continuous block within the adductor canal, and it remains unclear whether similar clinical benefits are obtained irrespective of block location. In this randomized, double-blind, noninferiority study, we hypothesized that a continuous proximal ACB provides postoperative analgesia that is no worse than a continuous distal ACB. ⋯ ClinicalTrials.gov (NCT02701114).
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Reg Anesth Pain Med · Jan 2018
ReviewTransversus Abdominis Plane Catheters for Analgesia Following Abdominal Surgery in Adults.
Transversus abdominis plane (TAP) catheters are increasingly being used as an opioid-sparing analgesic technique following abdominal surgery. The aim of this systematic review is to evaluate the efficacy and safety of TAP catheters for postoperative analgesia following abdominal surgery in adults. ⋯ Because of the extremely heterogeneous nature of the studies, a specific consensus regarding their results, or the ability to construct a meta-analysis, is unviable. Although there are promising indications for the benefit of TAP catheter techniques, extrapolation/comparison of results and application to patient care will be better elucidated when there is more standardization of TAP catheter techniques and the methodology for measuring efficacy.
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Reg Anesth Pain Med · Jan 2018
Comparative StudyThe Use of Regional or Neuraxial Anesthesia for Below-Knee Amputations May Reduce the Need for Perioperative Blood Transfusions.
Amputations of the lower extremity remain a common procedure in a high-risk population. Perioperative morbidity and mortality reach as high as 14.1% in below-knee amputations. We aimed to determine whether regional, or neuraxial, anesthesia, when compared with general anesthesia (GA), would be associated with reduced perioperative morbidity and mortality. ⋯ Regional anesthesia does not offer a mortality advantage over GA, but RA may reduce the need for perioperative blood transfusions.