Administration Of Regional Anesthesia Research Articles

Association of Patient Race and Hospital with Utilization of Regional Anesthesia for Treatment of Postoperative Pain in Total Knee Arthroplasty: A Retrospective Analysis Using Medicare Claims.

Regional anesthesia for total knee arthroplasty has been deemed high priority by national and international societies, and its use can serve as a measure of healthcare equity. The association between utilization of regional anesthesia for postoperative pain and (1) race and (2) hospital in patients undergoing total knee arthroplasty was estimated. The hypothesis was that Black patients would be less likely than White patients to receive regional anesthesia, and that variability in regional anesthesia would more likely be attributable to the hospital where surgery occurred than race. This study used Medicare fee-for-service claims for patients aged 65 yr or older who underwent primary total knee arthroplasty between January 1, 2011, and December 31, 2016. The primary outcome was administration of regional anesthesia for postoperative pain, defined as any peripheral (femoral, lumbar plexus, or other) or neuraxial (spinal or epidural) block. The primary exposure was self-reported race (Black, White, or Other). Clinical significance was defined as a relative difference of 10% in regional anesthesia administration. Data from 733,406 cases across 2,507 hospitals were analyzed: 90.7% of patients were identified as White, 4.7% as Black, and 4.6% as Other. Median hospital-level prevalence of use of regional anesthesia was 51% (interquartile range, 18 to 79%). Black patients did not have a statistically different probability of receiving a regional anesthetic compared to White patients (adjusted estimates: Black, 53.3% [95% CI, 52.5 to 54.1%]; White, 52.7% [95% CI, 52.4 to 54.1%]; P = 0.132). Findings were robust to alternate specifications of the exposure and outcome. Analysis of variance revealed that 42.0% of the variation in block administration was attributable to hospital, compared to less than 0.01% to race, after adjusting for other patient-level confounders. Race was not associated with administration of regional anesthesia in Medicare patients undergoing primary total knee arthroplasty. Variation in the use of regional anesthesia was primarily associated with the hospital where surgery occurred.

Regional Anesthesia With Paravertebral Blockade Is Associated With Improved Outcomes in Patients Undergoing Minithoracotomy Cardiac Surgery.

Severe postoperative pain has been shown to affect many patients following minimally invasive cardiac surgeries (MICS). Multimodal pain management with regional anesthesia, particularly by delivery of local anesthetics using a paravertebral catheter (PVC), has been shown to reduce pain in operations involving thoracotomy incisions. However, few studies have reported high-quality safety and efficacy outcomes of PVCs following MICS. Patients who underwent MICS at Vancouver General Hospital between 2016 and 2019 (N = 123) were reviewed for perioperative opioid-narcotic use. Primary outcomes were postoperative opioid use and hospital length of stay (LOS). Statistical analyses were performed using univariate and multivariable regression models to determine independent risk factors. A total of 54 patients received routine systemic analgesia (control), 53 patients received a paravertebral catheter (PVC), and 16 patients received another mode of regional analgesia (non-PVC). The mean hospital LOS was significantly different in patients in the PVC group at 5.8 ± 2.0 days versus 8.3 ± 7.1 days in the control and 6.6 ± 2.3 days in the non-PVC group (P = 0.033). The percentage of patients who did not require postoperative oxycodone was significantly higher in the PVC group (48.1%), compared with the control (24.5%) and non-PVC (37.5%; P = 0.043) groups. The administration of regional anesthesia using PVCs was associated with reduced need for opioids and a shorter LOS. The reduction in postoperative opioids may reduce the risk of potential opioid dependency in this population. Future studies should involve randomized controlled trials with systematic evaluation of pain scores to verify current study results.

Cryoanesthesia with ethyl chloride spray versus 5% lidocaine gel in alleviating oral local anesthetic injection pain for buccal anaesthesia: A randomized clinical (controlled) trial.

Numbing the area of oral mucosa with cold application prior to administration of regional anesthesia has been widely used by various dentists in alleviating pain caused by needle prick. Cryoanesthesia using Endo-ice as topical anesthesia has been studied as a replacement to prevail the fallibility of topical anaesthetics. This study aimed to evaluate and compare effectiveness of ethyl chloride spray with 5% lidocaine gel in alleviating buccal anesthesia injection pain. Total of 90 outpatients were randomly divided into 3 groups as follows: Group 1 - cryotherapy with ethyl chloride at the anesthetic site preceding before administration of local anesthesia; Group 2 - topical application of 5% LIDOCAINE GEL preceding before administration of local anesthesia; and group 3 - control that did not receive any topical agent preceding before administration of local anesthesia. Visual analogue scale (VAS) was used to document pain immediately after injection prick. About comparison of pain scores, significant difference was found between group 1 (ethyl chloride) and group 2 (topical lidocaine) patients (P=0.001). For group 1, about 15 (50%) patients suffered from mild pain, followed by 14 (46.67%) patients suffering from moderate pain. However, majority of the 21 (70%) patients in group 2 suffered from moderate pain. All the patients in group 3 suffered from severe pain. Importance of alleviating fear of needle injection phobia amongst patients is of paramount importance. Ethyl chloride was found to be more effective than topical lidocaine in alleviating needle injection pain before administration of local anesthetic injection.

Anticoagulation Regimens in Pregnancy.

This article explores current recommendations for anticoagulation therapy in pregnancy, including antepartum, intrapartum, and postpartum guidelines. The authors review various screening strategies used to assess whether a patient is an appropriate candidate for anticoagulation during pregnancy and the postpartum period. The article includes dosing regimens, optimal surveillance, and medication reversal. The authors also address the challenges of transitioning between low-molecular-weight heparin and unfractionated heparin. Finally, there is a discussion of intrapartum anticoagulation management, especially as it relates to the administration of regional anesthesia, and the indications for and timing of thromboprophylaxis following delivery.

Morphometric Analysis of the Supraorbital Foramen and Notch in the Population of Bosnia and Herzegovina.

The aim of this study was to learn about the morphological characteristics of the supraorbital foramen and to determine its precise position in relation to the surrounding anatomical landmarks in the adult population of Bosnia and Herzegovina. For this purpose, 60 skulls from the Bosnia and Herzegovina population of known sex (32 males and 28 females), taken from the osteological collection of the Department of Human Anatomy of the Medical Faculty in Sarajevo, were subjected to morphological and morphometric analysis. Morphometric measurements were performed using a digital vernier caliper (Mitutoyo Corporation, Japan). The study showed that most supraorbital nerves exit the orbit through the supraorbital notch (73.8%) and the rest through the foramen (26.2%). Of this number, bilateral supraorbital notches were recorded in 58.33% of cases, a bilateral supraorbital foramen in 18.34% of cases, while in 23.33% of cases a notch was recorded on one side and a foramen on the contralateral side. Morphometric measurements performed to determine the exact position of the supraorbital foramen relative to the surrounding landmarks showed different values in males and females. An accessory foramen was also observed on the examined skulls in 16.67% of cases. Detailed knowledge of anatomical variations of the supraorbital foramen is required for safe and successful administration of regional anesthesia, in order to avoid iatrogenic nerve injuries during orbitofacial region surgery.

Potential Therapeutic Application of Local Anesthetics in Cancer Treatment.

Local anesthetics are voltage-gated sodium channel blockers primarily administered locally or to the innervating nerves for anesthetic or analgesic purposes. In vitro studies have found direct effects of local anesthetics on cancer cells, such as impact on cancer cell proliferation, apoptosis, migration, invasion, and chemosensitivity, by multiple mechanisms. So far, in vivo evidence regarding the effect of local anesthetics on cancer cell lines is relatively lacking. Local and regional anesthesia administration has been reported to reduce postoperative pain and opioid use in cancer treatment. Additionally, regional anesthesia may reduce the perioperative stress response. However, the clinical therapeutic application of local anesthetics in cancer remains exploratory. In this review, we will discuss the direct and indirect effects of local anesthetics on cancer cells, and discuss the current evidence related to the use of local anesthetics in the treatment of cancer.

Use of Nitrous Oxide in Obstetrics

The introduction of nitrous oxide in a labor and delivery unit provides laboring patients with an additional option for coping with labor discomfort and anxiety. The use of nitrous oxide has been found to be helpful to patients who are coping with labor until the birth or until they request an epidural. Nitrous provides the opportunity to continue to remain ambulatory within their room, which may facilitate fetal descent. Patients’ preferences should be respected, and a wide variety of strategies should be available to meet each patient’s unique wants and needs. Nitrous oxide is an easily accessible alternate method to intravenous narcotics or regional anesthesia and may be amenable to patients who are hesitant to use other methods of coping in labor. Our PICO question was, in laboring patients, does the option of nitrous oxide prolong the time to regional anesthesia as measured by dilation progress prior to regional anesthesia administration or discontinuation of nitrous use?

Absence of Musculocutaneous Nerve: A Rare Anatomical Variation

Neural variation of the brachium constitutes a significant anatomical and clinical entity. The absence of Musculocutaneous Nerve is occasional in humans and accordingly there may be unforeseen clinical implication regarding the atypical innervations of musculature otherwise supplied by the Musculocutaneous Nerve. The present study is an absence of Musculocutaneous nerve observed during our routine educational dissection, where the lateral cord of brachial plexus took over the area of supply of Musculocutaneous Nerve by giving both the muscular and sensory branches. Knowledge of these variations is important in surgeries and during the administration of regional anaesthesia near shoulder joint and upper arm.

An informative video before planned cesarean delivery and maternal anxiety—a multicenter randomized controlled trial

Cesarean delivery is one of the most common procedures performed in obstetrics, and although cesarean delivery is a blissful occasion, it is commonly associated with fear and anxiety for the new mother. We aimed to study the impact of watching a detailed, informative video on maternal anxiety levels, childbirth experience, and patient satisfaction in patients undergoing a primary cesarean delivery. We performed a multicenter randomized control trial. Women scheduled to undergo a primary nonemergent cesarean delivery were recruited. All participants in the intervention group watched an informative video on recruitment. This 4-minute video described in detail the expected cesarean delivery process: preparations before entering the operation room, regional anesthesia administration, sterile covering, the surgical procedure itself, and recovery (including mobilization and lactation). Situation-specific anxiety was measured at recruitment, before exposure to the video (S1), at the day of the operation (S2), and at postpartum day 1 (S3) using the State-Trait Anxiety Inventory score. In addition, participants answered a 10-item Childbirth Experience Questionnaire. A sample size of 63 per group was planned to achieve 80% power to detect a difference of 5 points in the primary outcome (State-Trait Anxiety Inventory score on the day of the operation). Overall, 154 participants from 4 medical centers were randomized, and 132 participants were analyzed after completing all questionnaires, 64 participants in the video group and 68 participants in the control group. The groups did not differ in demographics and delivery characteristics and had similar baseline anxiety levels (S1). On operation day (S2, the primary outcome), significantly lower anxiety levels were reported in the video group than in the control group (State-Trait Anxiety Inventory scores, 41.3±9.5 vs 49.3±10.3; P<.001). Moreover, anxiety levels in postpartum day 1 (S3) remained significantly lower in the video group (P<.001). No difference between the groups in childbirth experience score or patient satisfaction was demonstrated. A detailed informative video shown to patients before primary cesarean delivery decreased maternal anxiety levels before and after the procedure.

Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know.

Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.

Variations of Median Nerve Formation in North Indian Population.

Introduction: The median nerve is usually formed by two roots contributed from the medial and lateral cords of the brachial plexus. Morphological variations of the median nerve can have clinical implications from the anesthetic and surgical points of view. In this cadaveric observation study, we report the variations of median nerve formation in the North Indian population.Methods: We observed the formation of the median nerve in 40 human cadaveric upper limb specimens. The specimens belonged to 20 right and 20 left upper limbs. Variations in the formation of the median nerve were noted.Results: Of the 40 dissected specimens, six (15%) had triple roots including a supernumerary root contributing to the medial nerve formation. The supernumerary root was a branch of the lateral cord in five cases, and it had an additional contribution from the medial cord in one case. The median nerve formation and continuation were located anterior or laterally in 39 specimens (97.5%) and medial in one (2.5%) in relation to the axillary artery.Conclusion: We observed supernumerary roots of varying morphology contributing to the median nerve formation. These variations should be considered during the administration of regional anesthesia and during the management of brachial plexus injuries. Further large multi-region studies will help in a better understanding of these variations.

Applied anatomy to the Gurcu Goat´s mandible in Kafkas and its clinical significance in regional anesthesia

Objective: This study was designed to provide important clinical signs for tracking nerves in the mandible during regional anesthesia in Georgian goats. Materials and methods: The study was conducted on the mandible bones of ten adult Gurcu goats of either sex (five male and five female). The mandible bone samples of naturally died Gurcu goat were collected from Kafkas University veterinary faculty education, research and application farm and processed as per the standard maceration technique. Altogether, 16 measurements were taken in the mandible bones of Gurcu goats by using a digital caliper and the results were expressed as mean and standard deviation. Results: The obtained parameters from the present study can be useful for an extraoral and intraoral approach for nerve block of mental and mandibular nerve in the mandibular regions of Gurcu goat. According to results The mandibular length and height was 158,86 ± 10,37 mm, 89,38 ± 5,81 mm, in females and 198,93 ± 3,85 mm, 114,5 ± 7,29 mm, in males of Gurcu goats, respectively. The distance between the first inferior incisor tooth and mental foramen and to the first premolar tooth was in females 19,72±2,3, 19,26 ± 0,44 mm, and 29,41 ± 6,10, 21,83 ± 1,02 mm, in males, respectively. The present study revealed that all the obtained parameters related to regional anesthesia showed a significant statistical difference (p&amp;lt;0,01**) between the males and females of Gurcu goat. Conclusion: It can be concluded from the present study that the various applied parameters of the present study is thought to assist clinicians in the administration of regional anesthesia in the lower jaw (mandibular region) area of the Gurcu goat.

Effectiveness and safety of intravenous dexmedetomidine sedation for ophthalmic surgery under regional anesthesia.

To assess the effectiveness and safety of intravenous (IV) dexmedetomidine for sedation in ophthalmic surgery. Prospective, observational, uncontrolled, single-center study. Patients were sedated with a continuous dexmedetomidine IV infusion started 15 min before regional anesthesia administration and maintained up to the end of surgery. Effectiveness of dexmedetomidine was assessed by the Modified Observer's Assessment of Alertness and Sedation (MOAA/S) targeted at 5. Safety was assessed by the incidence of patients' movements/snoring and by the incidence of respiratory and haemodynamic complications. An eleven-point numerical rating scale (NRS) was used to assess the level of satisfaction of both the surgeon and the patient. 123 patients (73 males, mean age: 63 ± 13) were included; 81 (81/123; 65.8%) patients reached the requested MOAA/S score of 5. Any intraoperative movement - mostly voluntary - occurred in 34 (34/123; 27.6%) cases with no need for a switch to general anaesthesia; no ocular complications related to the intraoperative movements occurred. Intraoperative snoring occurred in 30 (30/123; 24.4%) patients and it did not affect the surgical manoeuvres. Respiratory drive depression requiring manual or mechanical ventilation never occurred. Bradycardia occurred in 14 (14/123; 11.3%), cases but only 4 (4/123; 3.2%) patients required atropine administration, which was always effective. Intraoperative analgesia was consistently obtained and both the surgeons and the patients reported a high NRS satisfaction score. Dexmedetomidine provided adequate sedation in patients undergoing ocular surgery under local anaesthesia and showed a good effectiveness and safety profile. Upper airway obstruction, apnoea and snoring can occur.

Anesthetic choice for arteriovenous access creation: A National Anesthesia Clinical Outcomes Registry analysis.

We sought to evaluate differences in primary anesthetic type used in arteriovenous access creation with the hypothesis that administration of regional anesthesia and monitored anesthesia care (MAC) with local anesthesia as the primary anesthetic has increased over time. National Anesthesia Clinical Outcomes Registry data were retrospectively evaluated. Covariates were selected a priori within multivariate models to determine predictors of anesthetic type in adults who underwent elective arteriovenous access creation between 2010 and 2018. A total of 144,392 patients met criteria; 90,741 (62.8%) received general anesthesia. The use of regional anesthesia and MAC decreased over time (8.0%-6.8%, 36.8%-27.8%, respectively; both p < 0.0001). Patients who underwent regional anesthesia were more likely to have ASA physical status >III and to reside in rural areas (52.3% and 12.9%, respectively; both p < 0.0001). Patients who underwent MAC were more likely to be older, male, receive care outside the South, and reside in urban areas (median age 65, 56.8%, 68.1%, and 70.8%, respectively; all p < 0.0001). Multivariate analysis revealed that being male, having an ASA physical status >III, and each 5-year increase in age resulted in increased odds of receiving alternatives to general anesthesia (regional anesthesia adjusted odds ratios (AORs) 1.06, 1.12, and 1.26, MAC AORs 1.09, 1.2, and 1.1, respectively; all p < 0.0001). Treatment in the Midwest, South, or West was associated with decreased odds of receiving alternatives to general anesthesia compared to the Northeast (regional anesthesia AORs 0.28, 0.38, and 0.03, all p < 0.0001; MAC 0.76, 0.13, and 0.43, respectively; all p < 0.05). Use of regional anesthesia and MAC with local anesthesia for arteriovenous access creation has decreased over time with general anesthesia remaining the primary anesthetic type. Anesthetic choice, however, varies with patient characteristics and geography.

Regional anesthesia for nonunion surgery with iliac crest bone grafting results in an increase in same day discharge.

The purpose of this study was to evaluate the outcomes of fracture nonunion repair with autogenous iliac crest bone graft (ICBG) under regional anesthesia alone or in combination with other techniques compared to other anesthesia techniques. Overall, 137 patients were identified who underwent ICBG as part of a repair of a long bone fracture nonunion between January 1, 2013 and October 1, 2020. Surgical and anesthetic records were reviewed to classify patients by anesthesia type. General, spinal, and regional anesthetics were used as either the primary anesthetic or as a combination of regional nerve block with general or spinal anesthesia. Administration of regional anesthesia alone or in combination with general or spinal anesthesia (RA) and general or spinal anesthesia only (GS) groups differed in nonunion site distribution (p < 0.001). RA patients were discharged the same day more often than GS patients (30.9% vs 10.0%, p = 0.009) and experienced fewer postoperative complications (p = 0.021). The RA group achieved union sooner than the GS group (by 5.3 ± 3.2months vs. by 6.8 ± 3.2months, p = 0.006). Mean morphine equivalent dose was similar between groups (p = 0.23). Regional anesthesia use increased from 2013 to 2020, and same day discharge surgeries simultaneously increased over the same time period. Regional anesthesia use increased in nonunion repair surgery with ICBG from 2013 to 2020. This was associated with an increase in same day discharge, sooner time to union, and decreased postoperative complications. There was not a need for increased opioid prescription in patients that underwent regional anesthesia.

A Single Institutional Study on Pregnancy Outcomes in Patients with Von Willebrand Disease

Background:Von Willebrand Disease (VWD) is the most common inherited bleeding disorder in the United States. Despite von Willebrand factor (VWF) antigen and activity levels rising during pregnancy particularly in those with type 1 disease, there are several obstetric concerns regarding patients with VWD, including epidural management, mode of delivery, fetal outcome, and postpartum hemorrhage. Current guidelines suggest achieving a VWF activity (RCoF) and factor VIII:C level of at least 50 IU/dL before delivery, with maintenance > 50% of normal for at least 3-5 days.Aim:To investigate the incidence of obstetric complications in women with VWD and correlate maternal and fetal outcomes with VWF levels.Methods:We conducted a single-institution retrospective observational study reviewing the charts of all women diagnosed with VWD at the Hemophilia Treatment Center from January 2000 to June 2017. We included women with single or multiple pregnancies. We assessed the following obstetric outcomes: bleeding episodes during pregnancy, mode of delivery, use of epidural anesthesia, perioperative management of bleeding, prophylactic measures during peripartum period, presence of postpartum hemorrhage or excessive incisional bleeding, rate of spontaneous fetal loss, VWF/VIII:C levels during perioperative period, and transfusions. We excluded women with other diagnosed bleeding disorders. Statistical analyses were performed using the unpaired Student's t test.Results:The charts of 231 females with VWD were reviewed. There were 71 total pregnancies from 46 patients that were evaluable. 93.5% (43/46) patients had Type 1 VWD. 9.9% (7/71) had bleeding prior to delivery which included ecchymoses, mucosal or gingival bleeding, vaginal spotting, or epistaxis. Regional epidural anesthesia was performed in 16.9% (12/71) of cases with no bleeding complications reported. 25.4% had documented C-sections and 60.6% had vaginal deliveries. Postpartum bleeding (defined as immediate or delayed excessive vaginal or incisional bleeding) occurred in 29.6% (21/71) of cases; 38.9% (7/18) who underwent C-section and 25.6% (11/43) in vaginal deliveries. 50% (6/12) developed heavy bleeding despite receiving preoperative desmopressin (DDAVP) or human factor VIII/human VWF complex. 61.9% (13/21) required transfusions of blood products (either packed red blood cells or platelets), surgical dilation and curettage, IV/IN DDAVP or FVIII/VWF concentrates. 7% (5/71) had complications which included two ectopic pregnancies, two miscarriages, and one stillbirth, and one of these resulted in postpartum heavy bleeding (20%).The baseline and third trimester factor VIII:C and RCoF levels of non-bleeders and bleeders are shown in Table 1. The absolute difference in baseline levels of FVIII:C and RCoF compared to third trimester levels in non-bleeders was statistically significant: FVIII:C (p=0.0001; absolute difference of 53.6 IU/dL), RCoF (p=0.0001; absolute difference of 65.7 IU/dL), respectively. There was no statistically significant rise in FVIII:C nor RCoF levels from baseline to third trimester in women who had bleeding events (Table 1).Discussion:A reasonable estimate for the rate of postpartum hemorrhage in the general population is 1-5%. Our study demonstrated a much higher rate of postpartum bleeding in patients with VWD with a higher rate of hemorrhage in C-sections than vaginal deliveries. In those patients selected for epidural administration of regional anesthesia there were no complications. It appears that the rise in factor VIII:C and RCoF levels from baseline predicted the absence of bleeding and a larger absolute increase of VIII:C and RCoF from baseline levels predicted the absence of postpartum bleeding. In patients with postpartum bleeding, there was a smaller absolute increase in factor VIII:C and RCoF. In both groups, there were bleeding events despite prophylactic treatment prior to delivery.Conclusion:Our study suggests that greater increases of factor VIII:C and RCoF from baseline may predict the absence of postpartum hemorrhage in patients with VWD. Larger studies are needed to further elucidate the relationship between factor VIII:C and RCoF levels at baseline and peripartum and the risk of postpartum hemorrhage. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

USG SAVED THE DAY: PRE-PROCEDURAL USG SPINE FOR SPINAL ANAESTHESIA IN A PARTURIENT WITH THORACO-LUMBAR SCOLIOSIS WITH POST BURN CONTRACTURE NECK

Introduction: Incidence of Scoliosis is approximately 2% and higher in females. Therefore, anaesthesiologist should be familiar with its implications for safe anaesthetic management1. Such parturients present unique challenges for administration of regional anaesthesia. Reporting one such case with a successful outcome using pre procedural Ultrasound spine for spinal anaesthesia. A 27 years, 39 weeks Case Report: primigravida of height 132 cm, with cephalo pelvic disproportion in labour with grade III scoliosis and post burn contractures involving neck, was posted for emergency cesarean section. Patient underwent surgery successfully under SAB after accessing spine by ultrasonography for identifying point of insertion, depth of intrathecal space &amp; needle trajectory.2 Ultrasound is Conclusion: boon for accessing spine in patient with difcult spinal anatomy and pregnancy for deciding correct spinal interspace and successful outcome with fewer attempts.

Prospective cohort study examining the use of regional anesthesia for early pain management after combat-related extremity injury

BackgroundNo studies have examined the long-term benefits of regional anesthesia (RA) for pain management after combat-related injury. The objective of this prospective cohort study was to examine the relationship between...

Advantages of Using Ultrasound in Regional Anesthesia for a Super-Super Obese Patient

&lt;p&gt;In this case report, we describe the use of ultrasound in the administration regional anesthesia for a super-super obese patient. A 23-year-old female patient (height 167.2 cm, weight 191.5 kg, body mass index 68.6 kg/m&lt;sup&gt;2&lt;/sup&gt;) was admitted to the hospital for surgical repair of an anterior talofibular ligament rupture. We used ultrasound to help facilitate the administration of regional anesthesia. In the sagittal view of the lumbar spine, (with the patient in a sitting position) we were able to identify the border between the sacrum and the lumbar vertebral; in the transverse view, we were able to identify the transverse process, posterior dura, vertebral body, and the distance from the skin to the posterior dura. After skin marking, regional anesthesia was successfully performed. Based on this case study, we suggest that ultrasound can be very useful in regional anesthesia for severely obese patients.&lt;/p&gt;

Loss of Resistance: A Randomized Controlled Trial Assessing 4 Low-fidelity Epidural Puncture Simulators

(Eur J Anaesthesiol 2017;34:602–608) Placing an epidural catheter for administration of regional anesthesia is considered to be a difficult skill for anesthesia residents to master. In one study, first-year residents had only an 80% success rate after 90 attempts at epidural catheter placement. With such a steep learning curve, it would be beneficial to have significant simulated experiences before performing the procedure on patients. Several simulators are commercially available for practicing identification of the epidural space using a loss of resistance (LOR) technique. However, these simulators can be quite expensive, ranging in price between €1500 and 3000. The use of various fruits have been studied to simulate the feel of LOR during epidural procedures with the banana found to best simulate the sensation. In this single-blinded, randomized, controlled study the investigators compared 3 commercially available simulators and a banana for their ability to simulate the LOR feel essential to successful epidural placement.