Showing papers in "Regional Anesthesia and Pain Medicine in 2010"

TL;DR: The ASRA consensus statements represent the collective experience of recognized experts in the field of neuraxial anesthesia and anticoagulation and are based on case reports, clinical series, pharmacology, hematology, and risk factors for surgical bleeding.

TL;DR: The American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity assimilates and summarizes current knowledge regarding the prevention, diagnosis, and treatment of this potentially fatal complication.

TL;DR: The classic description of local anesthetic systemic toxicity (LAST) generally described in textbooks includes a series of progressively worsening neurologic symptoms and signs occurring shortly after the injection of Local Anesthetic and paralleling progressive increases in blood local anesthesia concentration, culminating in seizures and coma as discussed by the authors.

TL;DR: Ultrasound guidance improves block characteristics (particularly performance time and surrogate measures of success) that are often block specific and that may impart an efficiency advantage depending on individual practitioner circumstances.

TL;DR: Vigilance, preparedness, and quick action will improve outcomes of this dreaded complication and should be considered early, and the treating physician should be familiar with the method.

TL;DR: The anatomy and technique of continuous oblique subcostal transversus abdominis plane block is described to produce a wider sensory blockade suitable for analgesia after surgery both superior and inferior to the umbilicus.

TL;DR: The addition of dexamethasone to mepvacaine prolongs the duration of analgesia but does not reduce the onset of sensory and motor blockade after ultrasound-guided supraclavicular block compared with mepivacaine alone.

TL;DR: There is evidence for UGRA reducing the occurrence of vascular puncture and the frequency of hemidiaphragmatic paresis, but there is at best inconclusive scientific proof that these surrogate outcomes are linked to actual reduction of their associated complications, such as local anesthetic systemic toxicity or predictable diaphagmatic impairment in at-risk individuals.

TL;DR: Propofol/paravertebral anesthesia-analgesia for breast cancer surgery alters a minority of cytokines influential in regulating perioperative cancer immunity.

TL;DR: After minor arthroscopic shoulder surgery, the addition of a continuous interscalene ropivacaine infusion to a single-injection interScalene block reduces pain, especially with movement, during the first 24 hrs.

TL;DR: The report suggests that intraneural injection during ultrasound-guided interscalene block carries a risk of neurologic complications.

TL;DR: Although relatively few studies have compared US guidance with established techniques, the available evidence suggests that the use of US guidance is a safe and effective means to facilitate correct needle placement and adequate spread of local anesthetic for truncal blocks.

TL;DR: No differences were observed between groups in terms of return of bowel function, duration of hospital stay, and postoperative pain control, suggesting that IV infusion of local anesthetic may be an effective alternative to epidural therapy in patients in whom epidural anesthesia is contraindicated or not desired.

TL;DR: This review aimed to define the various credible mechanisms that have been proposed to explain cardiovascular collapse and death after administration of local anesthetics, particularly after bupivacaine and related agents.

TL;DR: There was convincing evidence to support the use of US, with 15 of 19 studies demonstrating improved outcomes compared with existing techniques, and Ultrasound provides significant advantages when performing brachial plexus block including faster sensory block onset and greater block success.

TL;DR: An in-plane transverse US-guided TPVB using the described technique is feasible and has a high success rate, and correct catheter position in the thoracic paravertebral space was radiologically confirmed in all patients.

TL;DR: Testing the hypothesis that perineural dexmedetomidine provides a longer duration of analgesia than the same dose given subcutaneously in a peripheral nerve block in rats found it to be a peripherally mediated effect.

TL;DR: The minimum effective volume of ropivacaine 0.75% required to produce effective shoulder analgesia for an ultrasound (US)-guided block at the C7 root level with assessment of pulmonary function and hemidiaphragm was determined.

TL;DR: This animal study suggests that nerve expansion seen on ultrasound during intraneural injection of clinically relevant volumes of LA results in histologic but not functional nerve injury.

TL;DR: In this article, a prospective trial with 6 months of follow-up in which pulsed radiofrequency treatment of the greater and/or lesser occipital nerve was used to treat this neuralgia was reported.

TL;DR: Numerous studies have documented the safety of neuraxial anesthesia and analgesia in the anticoagulated patient and patient management is based on appropriate timing of needle placement and catheter removal relative to the timing of antICOagulant drug administration.

TL;DR: There is level 1b evidence to make a grade A recommendation that ultrasound guidance provides a modest improvement in block onset and quality of peripheral nerve blocks, especially for lower extremity.

TL;DR: The LD50 of rapid, high volume lipid infusion is an order of magnitude greater than doses typically used for lipid rescue in humans and supports the safety of lipid infusion at currently recommended doses for toxin-induced cardiac arrest.

TL;DR: In a cadaver model of needle tip placement for ultrasound-guided interscalene block, it was found that SEI occurred more frequently than expected.

TL;DR: The duration of sciatic nerve block with local anesthetics is longer in diabetic compared with nondi diabetic rats, and diabetic rats receiving lidocaine/clonidine or ropivacaine had more abnormal myelinated axon profiles than did nondiabetic rats receiving the same drug.

TL;DR: For popliteal sciatic nerve block, circumferential spread of LA, and separation of the nerve into its 2 components are associated with rapid surgical block.

TL;DR: The limited data available to date suggest that Neuraxial ultrasonography is a useful adjunct to physical examination, allowing for a highly precise identification of regional landmarks and a precise estimation of epidural space depth, thus facilitating epidural catheter insertion.

TL;DR: The purpose of this editorial is to briefly review the major ultrasound-guided catheter insertion approaches along with their relative potential strengths and weaknesses.

TL;DR: It is suggested that popliteal SNB distal to the bifurcation has a shorter onset time than SNB proximal to its b ifurcation, and therefore, it may be a good option when a fast onset for a surgical block is required.

TL;DR: Sufficient central nervous system drug concentrations are reached after oral administration of pregabalin, suggesting that postoperative pain hypersensitivity can be reduced.