Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · May 2024
Randomized Controlled TrialSingle-bolus injection of local anesthetic, with or without continuous infusion, for interscalene brachial plexus block in the setting of multimodal analgesia: a randomized controlled unblinded trial.
Previous trials favored a continuous interscalene brachial plexus block over a single injection for major shoulder surgery. However, these trials did not administer a multimodal analgesic regimen. This randomized, controlled unblinded trial tested the hypothesis that a continuous infusion of local anesthetic for an interscalene brachial plexus block still provides superior analgesia after major shoulder surgery when compared with a single injection in the setting of multimodal analgesia, inclusive of intravenous dexamethasone, magnesium, acetaminophen and ketorolac. ⋯ A continuous infusion of local anesthetic for an interscalene brachial plexus block does not provide superior analgesia after major shoulder surgery when compared with a single injection in the setting of multimodal analgesia, inclusive of intravenous dexamethasone, magnesium, acetaminophen and ketorolac. The findings of this study are limited by performance and detection biases.
-
The clavipectoral fascia plane block (CPB) is a novel anesthetic management strategy proposed by Valdes-Vilches for clavicle fractures. This study aimed to investigate the distribution of the injected solution around the clavicle and the surrounding tissues. ⋯ The CPB effectively distributes the administered solution in the anterosuperior region of the clavicular periosteum, superficial muscular plane, and supraclavicular nerves. However, it does not affect the posteroinferior region of the clavicular periosteum or the deep muscular plane, including the CPF.
-
Reg Anesth Pain Med · May 2024
Observational StudyRadiographic lead migration in percutaneous spinal cord stimulator trials.
Lead migration during spinal cord stimulator (SCS) trials is relatively neglected in the literature and presents a different set of challenges compared with fully implanted leads. There is no consensus on what constitutes a clinically significant amount of radiographic lead migration during SCS trials. We wished to evaluate the incidence and extent of radiographic lead migration during percutaneous SCS trials, to investigate the risk factors for lead migration and whether this has impacted on trial success. ⋯ Radiographic lead migration of approximately half of a vertebral level in a caudal direction can be expected during percutaneous SCS trials and this can be anticipated by siting leads half of a vertebral level higher to accommodate for this. Additional factors should be considered in the setting of radiographic lead migration to determine whether this can be considered clinically significant.