Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2014
Randomized Controlled TrialContinuous Right Thoracic Paravertebral Block Following Bolus Initiation Reduced Postoperative Pain After Right-Lobe Hepatectomy: A Randomized, Double-Blind, Placebo-Controlled Trial.
We hypothesized that continuous right thoracic paravertebral block, following bolus initiation, decreases opioid consumption after right-lobe hepatectomy in patients receiving patient-controlled intravenous analgesia with sufentanil. ⋯ Continuous right thoracic paravertebral block, following bolus initiation, has an opioid-sparing effect on sufentanil patient-controlled intravenous analgesia for right-lobe hepatectomy patients and reduces numerical rating scale pain scores at rest and with coughing in the first 24 postoperative hours.
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Reg Anesth Pain Med · Nov 2014
Comparative StudyA Valid and Reliable Assessment Tool for Remote Simulation-Based Ultrasound-Guided Regional Anesthesia.
The purpose of this study was to establish construct and concurrent validity and interrater reliability of an assessment tool for ultrasound-guided regional anesthesia (UGRA) performance on a high-fidelity simulation model. ⋯ This is the first study to demonstrate the validity and reliability of a Global Rating Scale assessment tool for use in UGRA simulation training. Although the checklist may require further refinement, the Global Rating Scale can be used for remote and on-site assessment of UGRA skills.
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Reg Anesth Pain Med · Nov 2014
Cervical Transforaminal Epidural Steroid Injections: A Proposal for Optimizing the Preprocedural Evaluation With Available Imaging.
Cervical transforaminal epidural steroid injection (CTFESI) has been used to treat cervical radicular pain; however, rare but serious complications such as cerebellar or spinal cord infarction have been reported. The most probable causes of the serious complications include vertebral artery trauma, spasm, or accidental arterial injection of particulate steroid. Several recommendations have been made to improve the safety of CTFESI; however, evaluation and risk assessment of the patient's anatomy by the interventionist have not been sufficiently emphasized. ⋯ Special attention should be paid to the vital structures such as the vertebral artery, neural foramen, and carotid artery. A preprocedural roadmap for the safest predicted needle trajectory can be created by simulation using the patient's available magnetic resonance imaging scans. These considerations may guide and help the interventionist to minimize the risk of inadvertent needle placement involving vital structures such as the vertebral artery or carotid artery.