Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2012
Longitudinal assessment of pain outcomes in the clinical setting: development of the "APOLO" electronic data capture system.
Data to fully evaluate the effectiveness of many commonly used interventions in the clinical pain management setting are inadequate. Clinical data collected for patient management often are not based on validated instruments, and this impedes the ability to conduct longitudinal research. To address these needs, modified patient intake and return visit forms were established and the Assessment of Pain Outcomes Longitudinal Electronic Data Capture system was developed. ⋯ Accuracy of data entry is excellent, with an error rate of 1 in 11,250 potential data points. Data output converts easily to standard statistical programs. The creation of a pain outcomes database using validated measures and clinically relevant data is feasible.
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Reg Anesth Pain Med · Jul 2012
Looking into learning: visuospatial and psychomotor predictors of ultrasound-guided procedural performance.
Despite widespread use of ultrasound in regional anesthesia, little understanding of the psychomotor and visuospatial skills required to achieve and maintain procedural proficiency exists. Despite its procedural nature, anesthesiology lags behind other fields in assessing technical aptitude among practitioners and trainees. The goals of this study were to measure relevant visuospatial and psychomotor aptitudes of anesthesia residents-in-training and to evaluate the relationship between these skill sets and the performance of ultrasound-guided regional anesthesia. ⋯ This study reveals that visuospatial aptitude is a better predictor of ultrasound-based procedural performance than psychomotor ability. The type of real-time visual feedback (indirect versus direct) used for hand-eye coordination significantly impacts procedural performance and has implications for anesthesia and other procedural specialties. The learning effect noted during initial ultrasound skill trials suggests visuospatial assimilation and underscores the importance of early ultrasound instruction.
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Reg Anesth Pain Med · Jul 2012
Editorial CommentConnective tissues associated with peripheral nerves.
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Peripheral nerve stimulation has a long history in regional anesthesia. Despite the advent of ultrasound-guided peripheral nerve blockade, nerve stimulation remains a popular technique used alone or, now, in combination with ultrasound-guided techniques. In light of this evolving utility of nerve stimulation, this is an appropriate time to review the basic concepts and knowledge base of this historically important tool. ⋯ However, current magnitude is neither 100% sensitive nor specific. Independent of technical ability, both the biological environment and the equipment used impact the current-distance relationship. Thus, successful electrical nerve stimulation is dependent on an anesthesiologist with a solid foundation in anatomy and a thorough understanding of electrophysiology.