Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2007
Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia.
Ultrasound-guided regional anesthesia is a rapidly growing field. There exists little information regarding the competencies involved with such a practice. The objective of this exploratory study was to characterize the behavior of novices as they undertook the challenges of learning a new technique. In addition to assessing for both committed errors and accuracy, we aimed to identify previously unrecognized quality-compromising behaviors that could help structure effective training interventions. ⋯ Based on the analysis of the committed errors and the identification of quality-compromising behaviors, we are able to recommend important targets for learning in future training and simulation programs.
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Reg Anesth Pain Med · Mar 2007
A modified lateral approach to the sciatic nerve: magnetic resonance imaging simulation and clinical study.
The authors describe a new lateral approach to the sciatic nerve (SN) block in the popliteal fossa by using magnetic resonance imaging (MRI) and assessed its clinical feasibility. ⋯ Based on the MRI images, a needle inserted below the biceps femoris tendon provides an easy access point to the common peroneal and/or the tibial nerve. This modified lateral approach to the SN was easy to perform, had a high success rate, and was without complication in this small cohort.
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Reg Anesth Pain Med · Mar 2007
Electrical stimulation of the epidural space using a catheter with a removable stylet.
Electrical stimulation can be used to verify the location of epidural catheters. With the traditional technique, the latter must be primed with saline to allow for electrical conduction: any air lock will, thus, hinder the flow of current. Therefore, we set out to explore an alternative mode of stimulation by use of a catheter containing a removable stylet. This study examines the reliability of this new technique. ⋯ We conclude that the TheraCath, because of the removable stylet, provides effective electrostimulation of the epidural space. Its use was simple and devoid of complications. Nonetheless, further studies are required before implementing its routine use in clinical settings.
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Reg Anesth Pain Med · Mar 2007
Correlation between salivary alpha-amylase activity and pain scale in patients with chronic pain.
The visual analog scale (VAS) is commonly used to assess pain intensity. However, the VAS is of limited value if patients fail to reliably report. Objective assessments are therefore clearly preferable. Previous reports suggest that elevated salivary alpha-amylase may reflect increased physical stress. There is a close association between salivary alpha-amylase and plasma norepinephrine under stressful physical conditions. In this study, we have determined the usefulness of a portable salivary alpha-amylase analyzer as an objective biomarker of stress. ⋯ Because there was a significant correlation between VAS pain scale and salivary alpha-amylase, we suggest that this biomarker may be a good index for the objective assessment of pain intensity. In addition, a simple to use portable analyzer may be useful for such assessment.
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Today, there is a growing appreciation of the importance of the obturator nerve in clinical anesthesia. The aim of this study is to describe the ultrasound appearance of the obturator nerve for potential utility in guiding these nerve blocks. ⋯ The obturator nerve and its divisions are the flattest peripheral nerves yet described with ultrasound imaging. Knowledge of the obturator nerve's ultrasound appearance facilitates localization of this nerve for regional block and may increase success of such procedures.