Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2010
Subepineurial injection in ultrasound-guided interscalene needle tip placement.
The neural elements of the brachial plexus between the anterior and middle scalene muscles are readily visible by ultrasound. However, the epineurium of these nerve structures is difficult to discern on ultrasound imaging because of the proximity of the scalene muscles to the nerve elements, and this may lead to unintentional subepineurial injection (SEI). To evaluate whether typical needle tip placement under ultrasound guidance results in SEI, as opposed to extraneural injection, we undertook this cadaver study. ⋯ In a cadaver model of needle tip placement for ultrasound-guided interscalene block, we found that SEI occurred more frequently than expected.
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Reg Anesth Pain Med · Sep 2010
Comparative StudyPerineural dexmedetomidine provides an increased duration of analgesia to a thermal stimulus when compared with a systemic control in a rat sciatic nerve block.
The present study was designed to test the hypothesis that perineural dexmedetomidine provides a longer duration of analgesia than the same dose given subcutaneously in a peripheral nerve block in rats. ⋯ Sensory analgesia provided by dexmedetomidine added to ropivacaine for peripheral nerve blocks in rat is a peripherally mediated effect.
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Reg Anesth Pain Med · Sep 2010
Experience with 724 epidurograms for epidural catheter placement in pediatric anesthesia.
Epidural analgesia via continuous catheters, placed either via the caudal approach or directly at the desired level, is a commonly used technique in children. It is particularly important that these catheters are placed correctly because most are placed under general anesthesia and require deep sedation or repeat general anesthesia for replacement if malfunctioning. Ideally, correct placement should be confirmed at the time of insertion. ⋯ Our experiments suggest that confirmation of epidural catheter placement via epidurogram is highly efficacious. Epidurography is the only currently available technique that accomplishes all of the following: (a) confirms correct placement, (b) rules out incorrect anatomic space, and (c) predicts analgesic coverage.
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Reg Anesth Pain Med · Sep 2010
Comparative StudyComparison of bupivacaine, ropivacaine, and levobupivacaine in an equal dose and concentration for sympathetic block in dogs.
The aim of this study was to compare the potency of bupivacaine, ropivacaine, and levobupivacaine in an equal dose and concentration for sympathetic block. ⋯ Ropivacaine may induce a greater increase in vasodilation than bupivacaine and levobupivacaine at the same dose and concentration for sympathetic block in dogs.
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Reg Anesth Pain Med · Sep 2010
Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade: description of anatomy and clinical technique.
Recently, ultrasound-guided transversus abdominis plane blockade for abdominal wall analgesia has been described, and it involves injection of local anesthetic into the transversus abdominis plane. The posterior approach involves injection of local anesthetic in the lateral abdominal wall between the costal margin and the iliac crest and is suitable for postoperative analgesia after surgery below the umbilicus. The subcostal approach is suitable after abdominal surgery in the periumbilical region. The subcostal block can be modified, and the needle can be introduced along the oblique subcostal line from the xyphoid process toward the anterior part of the iliac crest. ⋯ A catheter can be placed along the oblique subcostal line in the transversus abdominis plane for continuous infusion of local anesthetic. Multimodal analgesia and intravenous opioid are used in addition because visceral pain is not blocked. Continuous oblique subcostal transversus abdominis plane block is a new technique and requires both a detailed knowledge of sonographic anatomy and technical skill for it to be successful.