Letters to the Editor: Letters & Announcements
To the Editor:
A recent article by Samson et al.1 demonstrates the beneficial effects of euctectic mixture of local anesthetic cream on reducing pain from both needle puncture and from needle redirection during humeral block placement in non-sedated patients.
Patient comfort during regional anesthesia is an important issue. A recent review article examines this issue2 and provides recommendations in this regard.
The ever-expanding role of ultrasound in regional anesthesia will also contribute to enhanced patient comfort and satisfaction. Ultrasound guided nerve blocks can decrease the number of needle passes required and avoid the uncomfortable muscle twitches associated with electrical stimulation.3,4 This is accompanied with an improved quality of block,5,6 faster onset of anesthesia5–8 and decreased volume of local anesthetic,8,9 which all increase patient comfort.
Michael J. O’Sullivan, MRCS
Department of Anaesthesia and Intensive Care Medicine
Midwestern Regional Hospital
1. Samson D, Minville V, Chassery C, Nguyen L, Pianezza A, Fourcade O, Rabinowitz A, Samii K. Eutectic Mixture of Local Anesthetic (EMLA) decreases pain during humeral block placement in non-sedated patients. Anesth Analg 2007;105:512–5
2. Hu P, Harmon D, Frizelle H. Patient comfort during regional anesthesia. J Clin Anesth 2007;19:67–74
3. Marhofer P, Greher M, Kapril S. Ultrasound guidance in regional anaesthesia. Br J Anaesth 2005;94:7–17
4. Marhofer P, Sitzwohl C, Greher M, Kapral S. Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia 2004;59:642–6
5. Williams SR, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D, Girard F. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesth Analg 2003;97:1518–23
6. Soeding PE, Sha S, Royse CE, Marks P, Hoy G, Royse AG. A randomised trial of ultrasound-guided brachial plexus anaesthesia in upper limb surgery. Anaesth Intensive Care 2005;33:719–25
7. Schwemmer U, Markus CK, Greim CA, Brederlau J, Roewer N. Ultrasound-guided anaesthesia of the axillary brachial plexus: efficacy of multiple injection approach. Ultraschall Med 2005;26:114–9
8. Marhofer P, Schrögendorfer K, Wallner T, Koinig H, Mayer N, Kapral S. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Med 1998;23:584–8
9. Sandhu NS, Maharlouei B, Patel B, Erkulwater E, Medabalmi P. Simultaneous bilateral infraclavicular brachial plexus blocks with low-dose lidocaine using ultrasound guidance. Anesthesiology 2006;104:199–201