Regional anesthesia and pain medicine
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To summarize the existing evidence behind the role of ultrasonography in neuraxial anesthesia techniques. ⋯ Neuraxial ultrasonography has been recently introduced to regional anesthesia practice. The limited data available to date suggest that it is a useful adjunct to physical examination, allowing for a highly precise identification of regional landmarks and a precise estimation of epidural space depth, thus facilitating epidural catheter insertion. Further research is needed to conclusively establish its impact on procedure success and safety profile, particularly in the adult nonobstetric population.
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Severe, systemic local anesthetic toxicity is arguably the most feared complication of regional anesthesia. A combination of old and new therapies is recommended to reduce the morbidity and mortality of symptomatic local anesthetic overdose. Prevention remains the criterion standard for improving patient safety during regional anesthesia. ⋯ Lipid infusion should be considered early, and the treating physician should be familiar with the method. We also recommend avoiding vasopressin and using epinephrine only in small doses. Vigilance, preparedness, and quick action will improve outcomes of this dreaded complication.
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Reg Anesth Pain Med · Mar 2010
ReviewUltrasound-guided interventional procedures in pain management: Evidence-based medicine.
Recently, there has been a growing interest in the application of ultrasonography in pain medicine because ultrasound provides direct visualization of various soft tissues and real-time needle advancement and avoids exposing the health care provider and the patient to the risks of radiation. The machine itself is more affordable and transferrable than a fluoroscopy, computed tomography scan, or magnetic resonance imaging machine. These factors make ultrasonography an attractive adjunct to other imaging modalities in interventional pain management especially when those modalities are not available or feasible. The present article reviews the existing evidence that evaluates the role of ultrasonography in spine interventional procedures in pain management.
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Reg Anesth Pain Med · Mar 2010
Nerve expansion seen on ultrasound predicts histologic but not functional nerve injury after intraneural injection in pigs.
Intraneural injection can be seen as nerve expansion during ultrasound-guided regional anesthesia. The purpose of this animal study was to determine if nerve expansion seen on ultrasound during intraneural injection results in nerve injury. ⋯ This animal study suggests that nerve expansion seen on ultrasound during intraneural injection of clinically relevant volumes of LA results in histologic but not functional nerve injury.
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Reg Anesth Pain Med · Mar 2010
Practice GuidelineThe American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy joint committee recommendations for education and training in ultrasound-guided regional anesthesia.
Ultrasound-guided regional anesthesia (UGRA) is a growing area of both clinical and research interest. The following document contains the work produced by a joint committee from ASRA and the European Society of Regional Anesthesia and Pain Therapy. This joint committee was established to recommend to members and institutions the scope of practice, the teaching curriculum, and the options for implementing the medical practice of UGRA. ⋯ In both the residency and postgraduate pathways, training, competency, and proficiency requirements include both didactic and experiential components. The Joint Committee recommends that the decision to grant UGRA privileges be based at the individual institution level. Each institution that conducts UGRA is encouraged to support a productive quality improvement process.