Articles: nerve-block.
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We compared the diagnostic accuracy of lumbar facet blocks guided by either conventional fluoroscopy or CT fluoroscopy (CTF). Seventy-one blocks were performed with conventional fluoroscopy, and 58 were performed using CTF. ⋯ The CTF group had a greater percentage decrease in pain (79.5% +/- 31.1%) than did the conventional fluoroscopy group (55.5% +/- 38.0%; P < .0005). We conclude lumbar facet blocks by using CTF guidance results in greater diagnostic accuracy than do conventional fluoroscopy.
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Transcrural celiac block using the needle "walking off" the L1 vertebra technique may cause complications. We used patient-specific computed tomography (CT) images as a roadmap to perform the block under fluoroscopy. We present 1 case to describe the technique. ⋯ The modified technique avoided painful needle contact on the bone, reduced needle redirections, and decreased the possibility of vital organ puncture.
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Anesthesia and analgesia · May 2005
Neurologic sequelae after interscalene brachial plexus block for shoulder/upper arm surgery: the association of patient, anesthetic, and surgical factors to the incidence and clinical course.
We determined the incidence, distribution, and resolution of neurologic sequelae and the association with anesthetic, surgical, and patient factors after single-injection interscalene block (ISB) using levobupivacaine 0.625% with epinephrine 1:200,000 in subjects undergoing shoulder or upper arm surgery, or both, in 693 consecutive adult patients. After a standardized ISB, assessments were made at 24 and 48 h and at 2 and 4 wk for anesthesia, hypesthesia, paresthesias, pain/dysesthesias, and motor weakness. Symptomatic patients were monitored until resolution. ⋯ Variables identified as independent predictors of neurologic sequelae likely related to ISB were paresthesia at needle insertion and ISB site pain or bruising at 24 h. In contrast, surgery preformed in the sitting position, as well as ISB site bruising, was identified as a predictor of neurologic sequelae not likely related to ISB. In conclusion, neurologic sequelae after single-injection ISB using epinephrine mainly involve transient minor sensory symptoms.
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J Vasc Interv Radiol · May 2005
Spinal CT-guided interventional procedures for management of chronic back pain.
Image-guided interventional procedures have arisen as an alternative for management of back pain, with controversial indications and efficacy. This study describes the technique, clinical impact, and complications of computed tomography (CT)-guided infiltrations for the management of chronic back pain. ⋯ Spinal CT-guided infiltration constitutes an effective therapy for chronic back pain. This series confirms a low complication rate, good response, and high therapeutic value.
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Anesthesia and analgesia · May 2005
Patient-controlled interscalene analgesia after shoulder surgery: catheter insertion by the posterior approach.
Insertion and maintenance of an interscalene catheter is technically challenging using lateral or anterior approaches. We report a technique to provide continuous brachial plexus blockade through a 48-h infusion of ropivacaine 0.1% (5 mL/h with a 5 mL bolus dose, 20-min lockout interval) using a catheter inserted with cannula-over-needle technique on the posterior side of the neck in 120 patients undergoing shoulder surgery. All catheters were successfully placed. ⋯ Three patients complained of cervical pain. Pain scores as well as ropivacaine requirement via a patient-controlled analgesia device were low. Evaluation of acute and nonacute complications in a large-size study is needed to compare efficacy and safety of this approach with existing techniques.