Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2013
Multicenter Study Comparative StudyUltrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade.
The use of ultrasound for peripheral nerve blockade reduces the incidence of systemic local anesthetic toxicity by at least 65%, possibly 80%.
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Reg Anesth Pain Med · Jul 2013
The impact of analgesic modality on early ambulation following total knee arthroplasty.
Total knee arthroplasty is associated with moderate to severe pain, and effective analgesia is essential to facilitate postoperative recovery. This retrospective cohort study examined the analgesic and rehabilitation outcomes associated with 48-hour continuous femoral nerve block, local infiltration analgesia, or local infiltration analgesia plus adductor canal nerve block. ⋯ Local infiltration analgesia was associated with improved early analgesia and ambulation. The addition of adductor canal nerve block was associated with further improvements in early ambulation and a higher incidence of home discharge.
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Reg Anesth Pain Med · Jul 2013
Reporting functional outcome after knee arthroplasty and regional anesthesia: a methodological primer.
The introduction of ultrasound guidance for regional anesthesia has resulted in an explosion of interest in its use for postoperative analgesia, particularly for orthopedic surgery. Regional anesthesia demonstrates unequivocal superiority compared with systemic opioids with respect to analgesia, reduced opioid consumption, increased patient satisfaction, and earlier achievement of discharge criteria. Improved acute postoperative analgesia can facilitate effective rehabilitation. ⋯ Furthermore, the functional outcome measures are used inappropriately in terms of clinically meaningful difference, assessment intervals, and/or duration of follow-up. This report aims to address these issues by discussing functional outcomes used in the physiotherapy or orthopedic literature and their appropriate utilization, so that future research into the effects of regional anesthesia can be methodologically sound. Outcomes discussed include those that are physical-performance-based (ie, range of motion, quadriceps strength, Timed Up and Go test, 6-Minute Walk Test, Stair Time, and Self-paced Walk Test) and those that are self-reported (ie,Western Ontario and McMaster Universities Osteoarthritis Index, Knee Osteoarthritis Severity Score, Lower Extremity Function Scale).
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Reg Anesth Pain Med · Jul 2013
ReviewUltrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures. Part IV: hip.
Ultrasound-guided injection in pain medicine is emerging as a popular technique for pain intervention. It can be applied for the intervention procedures in the hip region. The objectives of this review article were to review the relevant anatomy and sonoanatomy of the hip joint and the trochanteric bursae, to describe the techniques for ultrasound-guided injections, and to examine the efficacy and accuracy of such injections.
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Reg Anesth Pain Med · Jul 2013
Randomized Controlled Trial Comparative StudyThe effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers.
Adductor canal block (ACB) has been suggested as an analgesic alternative to femoral nerve block (FNB) for procedures on the knee, but its effect on quadriceps motor function is unclear. We performed a randomized, blinded study to compare quadriceps strength following adductor canal versus FNB in volunteers. Our hypothesis was that quadriceps strength would be preserved following ACB, but not FNB. Secondary outcomes included relative preservation of hip adduction and degree of balance impairment. ⋯ Compared with FNB, ACB results in significant quadriceps motor sparing and significantly preserved balance.