Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Jan 2002
Infraclavicular block with lateral approach and nerve stimulation: extent of anesthesia and adverse effects.
The infraclavicular approach to the brachial plexus is little used despite theoretical advantages of the technique. Using a vertical paracoracoid approach, we assessed the extent of the sensory block and the incidence of adverse effects. ⋯ Single injection infraclavicular block, using a vertical paracoracoid approach, appears suitable for surgery distal to the elbow. Selective anesthesia of the medial cutaneous nerve is useful in improving tolerance of the tourniquet.
-
Interscalene brachial plexus block is often used for surgeries involving the shoulder and upper arm. Known complications include phrenic nerve paralysis, intravascular injection, and cervical epidural block. We report a patient who developed acute hypoxia immediately following this block, presumably secondary to an acute pulmonary thromboembolus (PTE) coupled with phrenic nerve paralysis. ⋯ This case report suggests that manipulations and vasodilation related to an interscalene block may have facilitated the dislodgement of a pre-existing upper extremity thrombus.
-
Reg Anesth Pain Med · Jan 2002
Case ReportsA portable mechanical pump providing over four days of patient-controlled analgesia by perineural infusion at home.
Local anesthetics infused via perineural catheters postoperatively decrease opioid use and side effects while improving analgesia. However, the infusion pumps described for outpatients have been limited by several factors, including the following: limited local anesthetic reservoir volume, fixed infusion rate, and inability to provide patient-controlled doses of local anesthetic in combination with a continuous infusion. We describe a patient undergoing open rotator cuff repair who was discharged home with an interscalene perineural catheter and a mechanical infusion pump that allowed a variable rate of continuous infusion, as well as patient-controlled boluses of local anesthetic for over 4 days. ⋯ Continuous, perineural local anesthetic infusions are possible on an ambulatory basis for multiple days using a portable, programmable pump that provides a variable basal infusion rate, patient-controlled boluses, and a large anesthetic reservoir.
-
Reg Anesth Pain Med · Jan 2002
Regional anesthesia and pain medicine: residency training--the year 2000.
A survey of anesthesiology training programs in 1980 reported the use of a regional anesthetic technique in 21.3% of cases. A similar survey of anesthesiology training programs in 1990 reported that the use of regional anesthetic techniques had increased to 29.8%. Over the ensuing 10 years, additional changes have occurred in the field of anesthesiology and its United States residency training programs. This manuscript reports the impact these changes have had on the use of regional anesthesia techniques in residency training programs in the year 2000. ⋯ Anesthesiology training programs now appear to provide a satisfactory exposure to regional anesthesia for a majority of resident trainees, although 40% of residents may still be deficient in nerve block anesthesia. The growth in the use of regional anesthesia during residency has plateaued over the past decade, but the discrepancy between individual resident experience has improved.