Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2016
The Wiley Spinal Catheter-Over-Needle System for Continuous Spinal Anesthesia: A Case Series of 5 Cesarean Deliveries Complicated by Paresthesias and Headaches.
Intrathecal catheter devices using a catheter-over-needle design and softer flexible material have been introduced to clinical practice with the aim of reducing some of the complications such as postdural puncture headaches and paresthesias seen with previous versions of intrathecal catheters. We present a case series of 5 cesarean deliveries using the Wiley Spinal intrathecal system (Epimed, Johnstown, New York), which was recently approved by the US Food and Drug Administration. ⋯ Although the unique catheter-over-needle design facilitates the use of smaller-gauge spinal needles for dural puncture and larger-gauge catheters for medication administration, this case series using the Wiley Spinal suggests that paresthesias and postdural puncture headaches may still limit its widespread utilization. Future studies are needed to determine the true incidence of complications and to determine the role of continuous spinal anesthesia in the obstetric population.
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Reg Anesth Pain Med · May 2016
Randomized Controlled TrialSystemic Lidocaine Fails to Improve Postoperative Pain, But Reduces Time to Discharge Readiness in Patients Undergoing Laparoscopic Sterilization in Day-Case Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial.
Perioperative systemic lidocaine provides postoperative analgesia, decreases opioid consumption, and facilitates rehabilitation in abdominal surgery. We hypothesized that systemic lidocaine has analgesic effects in women undergoing day-case laparoscopic sterilization. ⋯ In laparoscopic sterilization, systemic lidocaine reduces time to readiness for hospital discharge.
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Reg Anesth Pain Med · May 2016
Randomized Controlled Trial Comparative StudyEvaluation of a New Needle Guidance System for Ultrasound: Results of a Prospective, Randomized, Blinded Study.
Accurate needle control during ultrasound (US)-guided nerve blocks may be an elusive goal for the anesthesiologist. Despite modifications to increase echogenicity, needle visibility still requires precise alignment within the transducer beam. In this study, we evaluated a magnetically guided ultrasound (MGU) system that produces a real-time, graphic display of the needle position and trajectory that is independent of the US beam. ⋯ In a tissue model, the MGU system improved control of needle trajectory and needle tip position for both inexperienced and experienced subjects.
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Reg Anesth Pain Med · May 2016
Case ReportsLumbar Epidural Hematoma Following Interlaminar Fluoroscopically Guided Epidural Steroid Injection.
Spinal epidural steroid injections are generally considered a safe, effective treatment for radicular pain in a variety of spinal conditions. Complications secondary to these injections, although rare, can result in devastating neurologic symptoms. Patients with preexisting moderate-to-severe spinal stenosis and recent use of chronic anticoagulation pose a challenging dilemma when making treatment decisions, as a history of both can increase the risk of complications. ⋯ This case report describes the potential risk factors present in this patient. Presence of spinal stenosis and the interlaminar approach seem to be significant risk factors in this case. Presence of an intrinsic coagulopathy was not determined.