Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2007
An assessment tool for brachial plexus regional anesthesia performance: establishing construct validity and reliability.
Technical proficiency in regional anesthesia is often determined subjectively through in-training evaluations. Objective assessment tools improve these evaluations by providing criteria for measurement. However, any evaluation instrument needs to be valid and reliable before it is adopted into a curriculum. The purpose of this study is to determine the validity and reliability of a devised assessment of residents performing an interscalene brachial plexus block (ISB). ⋯ Both assessment modalities were valid, in that they reliably discriminated between different levels of training. Objective measures of technical skills are feasible, timely, and improve the validity and reliability of competency assessments.
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Reg Anesth Pain Med · Jan 2007
Disclosure of risks associated with regional anesthesia: a survey of academic regional anesthesiologists.
In view of the relatively few large studies available to estimate the rates of complications following regional anesthesia, we aimed to identify and quantify the risks that academic regional anesthesiologists and regional anesthesia fellows disclose to their patients before performing central and peripheral nerve blockade. ⋯ The risks of regional anesthesia most commonly disclosed to patients by academic regional anesthesiologists and regional anesthesia fellows are benign in nature and occur frequently. Severe complications of regional anesthesia are far less commonly disclosed. The incidences of severe complications disclosed by academic regional anesthesiologists and their fellows can be inconsistent with those cited in the contemporary literature.
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Reg Anesth Pain Med · Jan 2007
Uniform distribution of skin-temperature increase after different regional-anesthesia techniques of the lower extremity.
Skin-temperature increase is a reliable but late indicator of success during regional-anesthesia techniques. The goal of this study is to determine the distribution of skin-temperature changes during different regional techniques. Does skin temperature increase in the whole area innervated by the blocked neural structures or only in certain regions within this area with the capability to react preferentially to sympathetic block (i.e., vessel-rich skin)? Although onset time may vary between different regional-anesthetic techniques, we hypothesized that the distribution of skin warming is equal. ⋯ Irrespective of the applied regional-anesthetic technique, skin-temperature changes are more pronounced distally. Thermography prevents false measurements of skin temperature above subcutaneous veins and displays flow of cold blood as the mechanism of initial skin-temperature drop after regional anesthesia. Measurements of skin-temperature increase cannot be used to evaluate the extent of analgesia or sympathetic block.
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Pain arising in the lumbar spine can have many etiologies, nearly 80% of which cannot be established with certainty. We present a very rare cause of back pain. ⋯ Hydatid cyst can be included in the differential diagnosis of lumbar back pain, especially in the endemic areas.
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Reg Anesth Pain Med · Jan 2007
Facilitating needle alignment in-plane to an ultrasound beam using a portable laser unit.
Ultrasound guidance can increase success with peripheral nerve blocks. Accurate anesthetic injection is optimized with both clear visualization and fine adjustment of the needle tip at the target area. Good needle alignment with the ultrasound beam and using a freehand technique are both desirable for these conditions. The purpose of this report is to describe how a unique, in-plane laser guide may be used to improve the alignment of injection needles with ultrasound beams in order to promote best needle tip visualization. ⋯ This in vitro demonstration describes the potential use of a readily available laser-line unit to assist with in-plane needle alignment with the ultrasound plane in order to ultimately improve needle visibility during ultrasound-guided peripheral nerve block. It requires minimum specialized training and may allow for maximum flexibility with freehand needle insertions in a sterile fashion.