Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2007
Randomized Controlled Trial Comparative StudyContinuous lumbar plexus block provides improved analgesia with fewer side effects compared with systemic opioids after hip arthroplasty: a randomized controlled trial.
A single injection lumbar plexus block for acute pain management after hip surgery is usually limited to the immediate postoperative period. We conducted a randomized controlled trial to determine the effect of a continuous lumbar plexus block on perioperative opioid requirements and pain intensity. ⋯ Continuous lumbar plexus block combined with PCA is superior to PCA alone for postoperative pain management following hip replacement. It reduces opioid requirements, opioid related side effects, and enhances patient satisfaction. However, additional research is required to determine its safety in light of the neurologic injury observed.
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Reg Anesth Pain Med · Sep 2007
Transversus abdominis plane block: a cadaveric and radiological evaluation.
The abdominal wall is a significant source of pain after abdominal surgery. Anterior abdominal wall analgesia may assist in improving postoperative analgesia. We have recently described a novel approach to block the abdominal wall neural afferents via the bilateral lumbar triangles of Petit, which we have termed a transversus abdominis plane block. The clinical efficacy of the transversus abdominis plane block has recently been demonstrated in a randomized controlled clinical trial of adults undergoing abdominal surgery. ⋯ These findings define the anatomic characteristics of the transversus abdominis plane block, and underline the clinical potential of this novel block.
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Needle visibility is a crucial requirement for successful and safe ultrasound-guided peripheral nerve blocks. We performed a prospective study on the ultrasonic imaging quality of various commercially available needles. We tested the hypothesis that different nerve block needles would have different ultrasonic appearances. Furthermore, we examined the influence of needle angle with regard to the ultrasound plane, 2 types of media surrounding the needle, and the impact of 3 different ultrasound machines. ⋯ In a tissue-equivalent model we found significant differences among different types of needles at a 45 degree angle. In clinical use, angles between 30 degrees and 60 degrees are required. Because visibility of the needle is a keystone of ultrasound-guided peripheral nerve blocks, our results suggest the need to optimize the echogenicity of needles used for ultrasound-guided nerve blocks.