Regional anesthesia and pain medicine
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Regional blocks are frequently invasive procedures that create the risk of infection, local anesthetic toxicity, and wrong-site performance. National guidelines have been developed by the Joint Commission and the American Society of Regional Anesthesia and Pain Medicine (ASRA) to reduce the potential for each of these risks. ⋯ A task force appointed by the ASRA President reviewed available resources and recommendations and performed a survey of RAPM members at the ASRA annual meeting in May 2013 and proposed a 9-point checklist to fulfill this role. Although it is apparent that local modification will be needed, the basic points and principles should be adopted for the performance of regional blocks.
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Reg Anesth Pain Med · May 2014
Off Side! A Simple Modification to the Parasagittal In-Plane Approach for Paravertebral Block.
The use of thoracic paravertebral blocks (PVBs) for breast cancer surgery confers important analgesic benefits. Several ultrasound (US)-guided PVB approaches have been described, but still elusive is the ideal technique that (1) permits continuous visualization of the entire needle shaft and tip, (2) avoids aiming the needle tip and injectate directly toward the neuraxis, and (3) is easy to perform. ⋯ This brief technical report describes the "off-side" technique--a simple solution to the technical challenge posed by the double-fulcrum effect exerted first by the transducer and then by the adjacent inferior transverse process. Our "off-side" technique marks a departure from conventional US-guided regional anesthesia teaching that recommends positioning the target in the middle of the US field and may be useful in similar types of US-guided regional anesthesia procedures such as neuraxial blockade.