Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2010
ReviewEvidence basis for ultrasound-guided block characteristics: onset, quality, and duration.
This systematic review summarizes existing evidence for superior onset, quality, and duration of block for ultrasound (US) guidance versus other techniques for nerve localization. ⋯ There is level 1b evidence to make a grade A recommendation that US guidance provides a modest improvement in block onset and quality of peripheral nerve blocks. Ultrasound is rarely inferior to other techniques.
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Reg Anesth Pain Med · Mar 2010
ReviewUltrasound-guided regional anesthesia and patient safety: An evidence-based analysis.
The role of ultrasound-guided regional anesthesia (UGRA) in reducing the frequency of regional anesthetic-related complications is difficult to ascertain from analyzing the limited literature on the topic. This evidence-based review critically evaluates the contributions of UGRA to improved patient safety, particularly as compared with standard nerve localization tools. Randomized controlled trials that compared UGRA with another form of neural localization and case series of more than 500 patients were used to compare safety parameters. ⋯ Statistical proof for meaningful reduction in the frequency of extremely rare complications, such as permanent peripheral nerve injury, is likely unattainable. Although there is evidence for UGRA reducing the occurrence of vascular puncture and the frequency of hemidiaphragmatic paresis, as yet there is at best inconclusive scientific proof that these surrogate outcomes are linked to actual reduction of their associated complications, such as local anesthetic systemic toxicity or predictable diaphragmatic impairment in at-risk individuals. This evidence-based review thus strives to summarize both the power and the limitations of UGRA as a tool for improving patient safety.
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Reg Anesth Pain Med · Mar 2010
ReviewThe effect of stimulating versus nonstimulating catheter techniques for continuous regional anesthesia: a semiquantitative systematic review.
Stimulating catheters provide feedback regarding the location of the catheter tip in relation to the target nerve or plexus. There is debate concerning whether stimulating catheters may reduce the failure rate of postoperative analgesia or whether they may enhance functional recovery by providing superior and more reliable postoperative analgesia. ⋯ Published reports of randomized controlled trials provide evidence for a better analgesic effect from stimulating catheters. Future trials should be conducted in a standardized manner with uniform reporting of outcomes, which may facilitate future quantitative analysis.
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Reg Anesth Pain Med · Mar 2010
Randomized Controlled TrialWound spread of radiolabeled saline with multi- versus few-hole catheters.
Continuous wound infusion of local anesthetics is effective in postoperative pain management and may be useful in major joint arthroplasty, but the optimal technique for postoperative administration of local anesthetics in the wound awaits trials evaluating the optimal type of catheter (single-, few-, or multiholed catheters). ⋯ Wound spread of a bolus injection through 15-cm multiholed catheters versus triple-orifice epidural catheters is similar with subfascial catheter placement in total hip arthroplasty. Procedure-specific trials are required to evaluate the analgesic efficacy of postoperative administration of local anesthetic in the wound with different types of catheter before general recommendations can be made.
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Reg Anesth Pain Med · Mar 2010
ReviewUltrasound and review of evidence for lower extremity peripheral nerve blocks.
This qualitative systematic review summarizes existing evidence from randomized controlled trials (RCTs) comparing ultrasound (US) to alternative techniques for lower extremity peripheral nerve block. There were 11 RCTs of sufficient quality for inclusion. Jadad scores ranged from 1 to 4 with a median of 3. ⋯ In 2 studies, the optimal peripheral nerve stimulation technique may have not been used, resulting in a potential bias. No RCT reported US as inferior to alternative techniques in any outcome. There is level Ib evidence to make a grade A recommendation that US guidance provides improvements in onset and success of sensory block, a decrease in local anesthetic requirements, and decreased time to perform lower extremity peripheral nerve blocks.