Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2016
Real-Time Detection of Periforaminal Vessels in the Cervical Spine: An Ultrasound Survey.
Compared with the thoracic and lumbar spine, transforaminal epidural injections and medial branch blocks in the cervical spine are associated with a higher incidence of neurological complications. Accidental breach of small periforaminal arteries has been implicated in many instances. In this observational study, using ultrasonography, we surveyed the incidence of periforaminal bloods vessels in the cervical spine. ⋯ Small periforaminal arteries are prevalent along the lateral aspect of the cervical spine, adjacent to areas commonly targeted by nerve block procedures. Further trials are required to determine if ultrasound guidance can reduce the incidence of complications related to accidental vascular breach.
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Reg Anesth Pain Med · Mar 2016
Accidental Dural Puncture Management: 10-Year Experience at an Academic Tertiary Care Center.
The use of spinal catheters for extended periods after accidental dural puncture (ADP) and administration of intrathecal saline via spinal catheters have been advocated to decrease the incidence of postdural puncture headache and the subsequent need for epidural blood patch (EBP), with mixed results observed. ⋯ Insertion of spinal catheters after ADP and administration of intrathecal normal saline via spinal catheters reduce the need for EBP compared with resiting the epidural. Administration of the standard epidural test dose intrathecally is associated with frequent and significant complications.