Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2009
Randomized Controlled Trial Comparative StudyA prospective, randomized comparison between single- and double-injection, ultrasound-guided supraclavicular brachial plexus block.
This prospective, randomized, observer-blinded study compared single- and double-injection, ultrasound-guided supraclavicular brachial plexus block for upper extremity surgery. ⋯ The double-injection, ultrasound-guided supraclavicular block provides no significant advantages compared with its single-injection counterpart.
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Reg Anesth Pain Med · Sep 2009
Comparative StudyDevelopment and validation of a new technique for ultrasound-guided stellate ganglion block.
Although the stellate ganglion is located anteriorly to the first rib, anesthetic block is routinely performed at the C6 level. Ultrasonography allegedly improves accuracy of needle placement and spread of injectate. The technique is relatively new, and the optimal approach has not been determined. Moreover, the location of the cervical sympathetic trunk relative to the prevertebral fascia is debatable. ⋯ This study revealed that, at the C6 level, the cervical sympathetic trunk lies entirely subfascially. Subfascial injection via the lateral approach ensures reliable spread of a solution to the stellate ganglion.
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Reg Anesth Pain Med · Sep 2009
Sonographic location of the radial nerve confirmed by nerve stimulation during axillary brachial plexus blockade.
: Visualization of the radial nerve can be a challenge during ultrasound-guided axillary blockade. The objective of this study was to plot the location and examine the sonographic appearance of the radial nerve in the axilla using both ultrasound visualization and nerve stimulator verification in patients undergoing axillary blockade. ⋯ : The radial nerve uncommonly lies immediately deep to the axillary artery. It is frequently located on the caudad side of the artery.
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Reg Anesth Pain Med · Sep 2009
Meningeal (postdural) puncture headache, unintentional dural puncture, and the epidural blood patch: a national survey of United States practice.
Meningeal (postdural) puncture headache (MPH) is a familiar iatrogenic complication. The optimal means of prevention, management, and treatment of this disorder are uncertain. The purpose of this study was to determine current practice among United States (USA) anesthesiologists regarding MPH as well as the related issues of unintentional dural puncture (UDP), the epidural blood patch (EBP), and proposed alternatives to the EBP. ⋯ Various measures, many poorly supported by the literature, are used prophylactically after UDP and in the treatment of MPH. Despite being nearly universally used as treatment of MPH, the EBP procedure itself remains largely nonstandardized.