CRNA : the clinical forum for nurse anesthetists
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Although the use of peripheral nerve stimulators and unsheathed needles in performing nerve blocks has been previously described, there has been a growing emphasis on the use of specific, expensive equipment to ensure success. The availability of equipment designed for use in peripheral nerve blocks, insulated needles and nerve stimulators, will help promote the use of these techniques, but the expense of purchasing this specialized equipment may contribute to a decline in performance of certain types of blocks. This article reviews the use of standard equipment, available in most anesthesia departments, for performing peripheral nerve blocks successfully.
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The increased use of continuous spinal anesthesia (CSA) in recent years has resulted in research efforts directed at reducing the complications associated with the technique. Complications of CSA are categorized as general, the same as those associated with single-shot spinal anesthesia, and specific, those associated solely with CSA. ⋯ The risk of developing the neurological complication of postdural puncture headache (PDPH) led to the use of microcatheters designed specifically for CSA. While the incidence of PDPH decreased with the use of microcatheters, the risk of developing the more serious complication of cauda equina syndrome increased, resulting in a Safety Alert being issued by the Food and Drug Administration.
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The use of adjuvant drugs for regional anesthesia may be indicated for a variety of reasons. Some general patient considerations, indications for the commonly used sedatives and analgesics, and administration techniques for these agents for patients having regional anesthesia are discussed.