Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2015
Randomized Controlled Trial Comparative StudyA Randomized Comparison Between Ultrasound- and Fluoroscopy-Guided C7 Medial Branch Block.
Because of its location in the lower neck and anatomical variability, the C7 medial branch represents a challenging target for local anesthetic blocks. Although ultrasound (US) guidance offers an alternative to fluoroscopy for C3 to C6 cervical medial branch blocks (CMBBs), its use at the C7 level has not been examined. We hypothesized that US, using a biplanar imaging technique, could provide a shorter performance time than conventional fluoroscopy for C7 CMBB. ⋯ Ultrasound guidance using a biplanar approach provides a similar success rate to fluoroscopy for C7 CMBB. However, US is associated with improved efficiency (decreased performance time and fewer needle passes).
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Reg Anesth Pain Med · Jan 2015
Ultrasound-Guided Lumbar Plexus Block Using a Transverse Scan Through the Lumbar Intertransverse Space: A Prospective Case Series.
A paramedian transverse scan (PMTS) can be used to delineate the anatomy relevant for ultrasound-guided lumbar plexus block (LPB) through the lumbar intertransverse space. This case series evaluated the feasibility of using the PMTS to guide LPBs for anesthesia. ⋯ Ultrasound-guided LPBs can be reliably accomplished using the PMTS.
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A cautionary summary of the benefits and potential risks of perineural dexamethasone.
"...there have been no reports of neurotoxicity or complications of any kind attributed to perineural dexamethasone in the nearly 700 patients who have received it in published studies of peripheral nerve blocks ... We must acknowledge that complications in regional anesthesia are rare, and 700 patients are woefully inadequate to declare dexamethasone safe for routine perineural use." (Noss 2014)
Noss concludes that:
- Perineural dexamethasone is probably safe, though conclusive safety evidence is still lacking.
- Systemic effects from IV dex is unlikely to explain the profound block prolongation.
- Prolongation is not enough on its own.