Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2016
ReviewThe Requisites of Needle-to-Nerve Proximity for Ultrasound-Guided Regional Anesthesia: A Scoping Review of the Evidence.
This scoping review examines the literature to determine whether the position of the needle tip relative to the target nerve is accurately and reliably detected during ultrasound (US)-guided regional anesthesia. The requisites for successful and safe needle tip positioning relative to the target nerve include accurate and reliable needle presentation by the machine, needle interpretation by the operator, nerve presentation by the machine, and nerve interpretation by the operator. Failure to visualize the needle tip is a common occurrence, frequently prompting operators to use needle and probe maneuvers, which are not necessarily based on evidence. Needle tip interpretation often relies on surrogate indicators that have not been validated. The acoustic resolution of modern portable US machines limits the extent to which nerve microanatomy can be reliably presented. Finally, our interpretation of the sonographic end points for local anesthetic injection that best balance success and safety for US-guided regional anesthesia continues to evolve. ⋯ In order to determine whether or not the position of the needle tip relative to the target nerve is accurately and reliably detected during US-guided regional anesthesia, the available literature is reviewed and interpreted to address the following 4 questions.
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Reg Anesth Pain Med · Jan 2016
ReviewUltrasound-Guided Interventional Procedures in Pain Medicine: A Review of Anatomy, Sonoanatomy, and Procedures: Part VI: Ankle Joint.
Ultrasound-guided injections in pain medicine are emerging as a popular technique for pain interventions. Ultrasound can be applied for procedures of the ankle joint and surrounding structures. This review describes the anatomy and sonoanatomy of the ankle joint, subtalar joint, and surrounding extra-articular structures relevant for intra-articular injection. Second, it reviews injection techniques and the accuracy and efficacy of these intra-articular ankle injections.
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Reg Anesth Pain Med · Nov 2015
ReviewA Review of Local Anesthetic Systemic Toxicity Cases Since Publication of the American Society of Regional Anesthesia Recommendations: To Whom It May Concern.
Local anesthetic systemic toxicity (LAST) occurrence may cross several medical specialties. In 2010, the American Society of Regional Anesthesia and Pain Medicine (ASRA) published the first algorithm on LAST management, introducing the use of lipid emulsion (ILE) treatment. ⋯ We also focused on the treatment measures that were applied in the different cases, especially on the use of ILE and adherence to ASRA recommendations. Despite the limits of a review of case reports, the present study calls attention to the insidious nature of LAST, especially its atypical manifestations, and shows that ILE may currently be underadministered in daily clinical practice, especially in nonanesthesiology practice.
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Reg Anesth Pain Med · Nov 2015
Review Meta AnalysisPreventive Acetaminophen Reduces Postoperative Opioid Consumption, Vomiting, and Pain Scores After Surgery: Systematic Review and Meta-Analysis.
Preventive analgesia has been proposed as a potential strategy to reduce postoperative pain. However, there is currently no review that focuses on acetaminophen for preventive analgesia. ⋯ To our knowledge, this is the first review to describe a potential preventive effect of acetaminophen. However, well-conducted randomized controlled trials are necessary to substantiate the conclusions of this review.