Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2017
Case Reports Comparative Study"A Tale of Two Planes": Deep Versus Superficial Serratus Plane Block for Postmastectomy Pain Syndrome.
Postmastectomy pain syndrome (PMPS) is a significant burden for breast cancer survivors. Although multiple therapies have been described, an evolving field of serratus anterior plane blocks has been described in this population. We describe the addition of the deep serratus anterior plane block (DSPB) for PMPS. ⋯ We illustrate 4 patients who have benefitted from a DSPB and describe indications that this block may be more efficacious than a superficial serratus plane block. Further study is recommended to understand the intercostal nerve branches within the lateral and anterior muscular chest wall planes.
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Reg Anesth Pain Med · Mar 2017
Comparative StudyUltrasound-Guided Needle Technique Accuracy: Prospective Comparison of Passive Magnetic Tracking Versus Unassisted Echogenic Needle Localization.
Ultrasound-guided regional anesthesia facilitates an approach to sensitive targets such as nerve clusters without contact or inadvertent puncture. We compared accuracy of needle placement with a novel passive magnetic ultrasound needle guidance technology (NGT) versus conventional ultrasound (CU) with echogenic needles. ⋯ Passive magnetic NGT can improve accuracy of needle procedures, particularly among OOP procedures requiring close approach to sensitive targets, such as nerve blocks in anesthesiology practice.
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Reg Anesth Pain Med · Mar 2017
Observational StudyThoracic Epidural Anesthesia and Prophylactic Three Times Daily Unfractionated Heparin Within an Enhanced Recovery After Surgery Pathway for Colorectal Surgery.
Venous thromboembolism (VTE) is a common cause of preventable harm. Perioperative thoracic epidural analgesia (TEA) presents a challenge to optimal VTE prophylaxis. Our primary aim was to characterize missed doses of VTE prophylaxis associated with epidural catheter placement and removal. Our secondary aim was to measure the effect of an enhanced recovery after surgery (ERAS) pathway on the rate of TEA-associated missed VTE prophylaxis. ⋯ Thoracic epidural analgesia was associated with a 1.5-fold increased risk of missed dose of preoperative VTE prophylaxis, which was not affected by implementation of an ERAS program. The implementation of an ERAS program reduced missed doses associated with epidural removal. This study highlights the challenge posed by providing VTE prophylaxis in the setting of perioperative neuraxial analgesia.
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The precise location of the adductor canal remains controversial among anesthesiologists. In numerous studies of the analgesic effect of the so-called adductor canal block for total knee arthroplasty, the needle insertion point has been the midpoint of the thigh, determined as the midpoint between the anterior superior iliac spine and base of patella. "Adductor canal block" may be a misnomer for an approach that is actually an injection into the femoral triangle, a "femoral triangle block." This block probably has a different analgesic effect compared with an injection into the adductor canal. We sought to determine the exact location of the adductor canal using ultrasound and relate it to the midpoint of the thigh. ⋯ In all volunteers, the midpoint of the thigh was proximal to the beginning of the adductor canal, suggesting that an injection performed at this level is in fact a femoral triangle block.