Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2012
Randomized Controlled Trial Comparative StudyA prospective, randomized comparison between double-, triple-, and quadruple-injection ultrasound-guided axillary brachial plexus block.
This prospective, randomized, observer-blinded study compared double-, triple-, and quadruple-injection ultrasound (US)-guided axillary brachial plexus block (AXB) for upper-extremity surgery. ⋯ Double-, triple-, and quadruple-injection US-guided perivascular AXB result in comparable success rates and total anesthesia-related times. Because it requires fewer needle passes, the double-injection technique provides a simple alternative for US-guided AXB.
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Reg Anesth Pain Med · May 2012
ReviewEpidural technique for postoperative pain: gold standard no more?
Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in postoperative pain management. However, newer, evidence-based outcome data show that the benefits of epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic epidural analgesia with local anaesthetic drugs only. ⋯ The number of indications for the use of epidural analgesia seems to be decreasing for a variety of reasons. The decision about whether to continue using epidural techniques should be guided by regular institutional audits and careful risk-benefit assessment rather than by tradition. For routine postoperative analgesia, epidural analgesia may no longer be considered the gold standard.
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Reg Anesth Pain Med · May 2012
The creation of an objective assessment tool for ultrasound-guided regional anesthesia using the Delphi method.
The assessment of technical skills in ultrasound-guided regional anesthesia is currently subjective and relies largely on observations of the trainer. The objective of this study was to develop a checklist to assess training progress and to detect training gaps in ultrasound-guided regional anesthesia using the Delphi method. ⋯ Using the Delphi method, a checklist and GRS were developed. These tools can serve as an objective means of assessing progress in ultrasound technical skills acquisition.
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Reg Anesth Pain Med · May 2012
Ultrasound-guided regional anesthesia: how much practice do novices require before achieving competency in ultrasound needle visualization using a cadaver model.
Ultrasound needle visualization is a fundamental skill required for competency in ultrasound-guided regional anesthesia. The primary objective of this study using a cadaver model was to quantify the number of procedures that novices need to perform before competency, using a predefined dynamic scoring system was achieved in ultrasound needle visualization skills. ⋯ Trainees became competent in ultrasound needle visualization at a variable rate. This study estimates that novices would require approximately 28 supervised trials with feedback before competency in ultrasound needle visualization is achieved.