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Anesthesiology:
Pain and Regional Anesthesia

Major Complications of Regional Anesthesia in France: The SOS Regional Anesthesia Hotline Service

Auroy, Yves M.D.*; Benhamou, Dan M.D.†; Bargues, Laurent M.D.*; Ecoffey, Claude M.D.‡; Falissard, Bruno M.D., Ph.D.§; Mercier, Frédéric M.D., Ph.D.∥; Bouaziz, Hervé M.D., Ph.D.#; Samii, Kamran M.D.**

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Abstract

Background: Several previous surveys have estimated the rate of major complications that occur after regional anesthesia. However, because of the increase in the use of regional anesthesia in recent years and because of the introduction of new techniques, reappraisal of the incidence and the characteristics of major complications is useful.
Methods: All French anesthesiologists were invited to participate in this 10-month prospective survey based on (1) voluntary reporting of major complications related to regional anesthesia occurring during the study period using a telephone hotline service available 24 h a day and managed by three experts, and (2) voluntary reporting of the number and type of regional anesthesia procedures performed using pocket booklets. The service was free of charge for participants.
Results: The participants (n = 487) reported 56 major complications in 158,083 regional anesthesia procedures performed (3.5/10,000). Four deaths were reported. Cardiac arrest occurred after spinal anesthesia (n = 10; 2.7/10,000) and posterior lumbar plexus block (n = 1; 80/10,000). Systemic local anesthetic toxicity consisted of seizures only, without cardiac toxicity. Lidocaine spinal anesthesia was associated with more neurologic complications than bupivacaine spinal anesthesia (14.4/10,000 vs. 2.2/10,000). Most neurologic complications were transient. Among 12 that occurred after peripheral nerve blocks, 9 occurred in patients in whom a nerve stimulator had been used.
Conclusion: This prospective survey based on a free hotline permanent telephone service allowed us to estimate the incidence of major complications related to regional anesthesia and to provide a detailed analysis of these complications.
IN France, the number of regional anesthetic procedures has increased 12-fold between 1980 and 1996. 1 This tremendous increase can be linked to the perception that regional anesthesia is associated with numerous advantages and with very few severe complications. 2 This increase has been seen not only in obstetrics but also for other surgical procedures. Numerous new techniques have been described during these two decades, and their use also explains the large development of regional anesthesia. Because major complications related to traditional techniques are rare, their exact incidence is known only approximately. 3 A previous prospective survey assessed the complication rate of 103,730 regional anesthetics and was based on the voluntary participation of 736 anesthesiologists. 3 However, in this study, complications were reported in detail on a written form, and the detailed numbers of each type of block performed were not recorded. Moreover, the incidence of major complications associated with the more recently introduced techniques could not be assessed at that time. Thus, we created a hotline service (SOS Regional Anesthesia Service) that had three main goals: (1) to provide online clinical help for the practitioner facing a severe complication, (2) to obtain immediately relevant clinical information for every complication reported, and (3) to estimate the incidence of complications from a prospective declaration of all regional techniques performed by practitioners who had subscribed to the service.
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Methods

Three weeks before the beginning of the study period, a letter was mailed to 8,150 French anesthesiologists introducing the concept of the hotline service and inviting them to participate in a survey of complications of regional anesthesia from August 1, 1998, to May 31, 1999. The service was free of charge. A 2-month period (June and July 1998) was used as a test period, and data collected during this initial phase were not entered into the database. The survey was divided into five periods of 2 months each. The participants were informed of the cellular phone number where they could reach one of three experts (D.B., C.E., K.S.) 24 h a day and 7 days a week for any question related to regional anesthesia (complication or advice). The participants were asked to report immediately any serious adverse event they encountered after regional anesthesia by calling the hotline. Nine severe complications were tallied: (1) cardiac arrest requiring cardiac massage and/or epinephrine; (2) acute respiratory failure requiring tracheal intubation and/or assisted ventilation; (3) seizures; (4) peripheral nerve injury, defined as a sensory and/or motor deficit with clinical and/or electrophysiologic abnormalities suggesting a peripheral site of injury and no evidence of spinal cord lesion; (5) cauda equina syndrome; (6) paraplegia; (7) cerebral complication; (8) meningeal syndrome; and (9) death. The complications described during each telephone call were recorded using a preprinted form. Postdeclaration follow-up of each case was performed by the expert who received the initial call.
Each expert remained “on call” during a 1-week period, at the end of which the cases were sent by electronic mail to the other experts for reading. During the week on call, each expert was autonomous for the responses given. However, because a given individual's expertise cannot be complete for every topic, the experts could communicate within the group to discuss difficult questions, ask for advice from experts outside of the group, or even delay nonurgent responses to improve their own knowledge by reading pertinent literature or consulting medical databases.
The events reported were later reviewed by the three experts to decide whether they should be included in the “serious complications” list. Then, serious complications were classified into three groups: (1) unrelated to regional anesthesia and entirely explained by nonanesthetic factors, (2) related to regional anesthesia, and (3) unclassified. Causal inference was decided by consensus among the experts and was based on the following factors: complication temporally related to regional anesthesia occurring in an anatomic area corresponding to the lesion (except for systemic complications) and no other obvious cause found. Three other experts (F. Bonnet, M.D., J. Hamza, M.D., and L-J Dupré, M.D., listed in the Acknowledgments) not involved in the overall process of the study were asked to provide their own conclusions on 20 randomly selected cases using the same classification.
To precisely calculate the incidence of complications after each type of block, the following system was organized to record all blocks performed. A 17-page pocket booklet was prepared, in which each page was dedicated to a specific regional block. Obstetric and pediatric cases were also specifically recorded. For spinal anesthesia, the drug used (bupivacaine or lidocaine) had to be recorded. After each anesthesiologist had agreed to participate, he or she was sent a booklet covering a 2-month period. At the end of this period, the booklets were returned, and a new one was sent by regular mail. The booklets were used only to report the number of blocks performed, whereas complications were reported via telephone calls.
Since, in the present study, one observation corresponds to one anesthetic procedure, and because each anesthesiologist reported several procedures, the observations are not independent from a statistical point of view. This phenomenon corresponds to a “cluster effect,” which leads to a bias in the calculation of the SD and the P value. To correct this bias, we used a bootstrap procedure 4 designed specifically for the present study through a routine in S-PLUS 2000 (MathSoft, Seattle, WA). The exact variance of the incidence of complications was computed in this way. The naive variance was also computed, and the ratio of both variances (design effect) was systematically between 2.2 and 2.4. Thus, all confidence intervals or statistical tests were computed using naive variance increased by a factor of 2.4.
In the tables and in the text, data that approximately follow a normal distribution are presented as mean ± SD, whereas non-normally distributed data that are widely skewed are presented as median with 25th and 75th corresponding percentiles. Pearson chi-square test was used for dichotomous categorical data. To compare continuous variables, the Student t test was used, except when the distribution was not normal, in which case the Mann-Whitney U test was used. Formulae based on the normal distribution were used to calculate 95% confidence intervals. When the distribution was not normal, tables of the Poisson distribution were used.
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Results

Table 1
Table 1
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During the five periods of 2 months each, 487 anesthesiologists out of 8,150 agreed to participate in the study. The participants who used the hotline service performed more blocks than the mean number of blocks performed by French anesthesiologists overall (table 1). Those who agreed to participate were allowed to subscribe at any time during the study and thus received 1–5 booklets. Overall, the participants reported performing 158,083 regional blocks, including 41,251 episodes of spinal anesthesia, 35,379 epidural blocks, 1,474 combined spinal-epidural blocks, 50,223 peripheral blocks, 4,448 episodes of intravenous regional anesthesia, 17,071 peribulbar blocks, and 8,237 other blocks. These blocks were performed for surgery in adults (74.3%), children (2.8%), or for obstetric purposes (22.9%). To ascertain that a valuable denominator had been obtained, 20 randomly chosen anesthesiologists (4.1%) who had participated in the study were asked to show their operating room records during the study period. Fifteen of them sent copies of their operating room lists within 1 month of request, allowing comparison between the numbers of blocks reported in the booklets during the study period and hospital records. Underestimation was found to be 4% (5% for spinal anesthesia, 3% for epidural anesthesia, and 2% for peripheral nerve blocks).
Table 2
Table 2
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Table 3
Table 3
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Table 4
Table 4
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Sixty-eight anesthesiologists out of 487 reported 77 serious complications as defined previously. There was no significant difference for any characteristics between those who reported at least one complication and those who did not report any (table 1). Table 2 shows that only 56 complications were classified as being related to regional anesthesia. Tables 3 and 4 show the number of blocks and the incidence of each type of complication for each type of block performed for adult nonobstetric and obstetric patients, respectively. Among the 1,474 cases of combined spinal-epidural anesthesia, the 4,448 episodes of intravenous regional anesthesia, and the 17,071 peribulbar blocks performed, no severe complications were recorded. In addition, no severe complications were reported in the 4,435 blocks performed in children. Secondary analysis of the 20 selected cases showed that the three experts not involved in the hotline service were in complete agreement with the conclusions provided by the hotline experts for 19 cases, whereas only two experts agreed on the one remaining case.
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Cardiac Arrest and Acute Respiratory Failure
Bradycardia was recorded before each cardiac arrest that occurred during spinal anesthesia. The three cardiac arrests followed by death were delayed (> 40 min after spinal injection) and occurred in elderly patients (> 80 yr) who had undergone hip surgery. One case of irreversible cardiac arrest occurred during a posterior lumbar plexus block. A sensory level higher than T2 and a bilateral mydriasis were noticed immediately before the arrest.
Respiratory failure occurred during the course of central blocks (spinal or epidural anesthesia) or posterior lumbar plexus blocks; none led to death. In all complications related to posterior lumbar plexus block, a high dermatomal level and a bilateral mydriasis were observed, suggesting intrathecal cephalad spread of the local anesthetic. In one case, the occurrence of respiratory failure was facilitated by preexisting morbid obesity. Finally, in one additional case, respiratory failure occurred after an erroneous dose was used during continuous spinal anesthesia.
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Seizures
Seven cases of seizures occurred after epidural (n = 1) or peripheral injection (n = 6) and were related to systemic toxicity of local anesthetics. Arrhythmias were not noted in any of the cases. In one additional case, seizures occurred during spinal anesthesia at the time of cardiac arrest.
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Neurologic Complications
Most neurologic complications completely resolved within 8 postoperative days. Twelve patients had a peripheral nerve injury (n = 9) or cauda equina syndrome (n = 3) after spinal anesthesia. In nine patients, neither pain nor paresthesia had been noted during puncture. All recovered completely within 3 weeks. Of those nine patients, five had received lidocaine, whereas the three patients who had paresthesia during the puncture had received bupivacaine. In the three patients in whom paresthesia occurred during the procedure, neurologic sequelae were still present 6 months later. Neurologic complications during spinal anesthesia occurred with a statistically different incidence regardless of whether lidocaine (5/3,459 or 14.4/10,000) or bupivacaine (7/31,980 or 2.2/10,000) had been used (P < 0.01).
Twelve other patients had a peripheral neuropathy after a peripheral block, and seven of them had sequelae still present after 6 months. Neurologic complications were observed in nine patients in whom a nerve stimulator had been used: two had described paresthesia during puncture, and in three cases a low intensity of stimulation (< 0.5 mA) had been used during the procedure.
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Discussion

With this free-of-charge regional anesthesia service involving the voluntary participation of 487 anesthesiologists, 158,083 regional blocks were prospectively recorded in a 10-month period. The calculated incidences of severe complications related to regional block are lower than 5 in 10,000 patients in this series. This “low” incidence a posteriori validates the concept that a large-scale study is necessary to assess this issue. The incidences observed are in the range of what has been observed in other studies, 5–15 particularly in the recent French survey. 3 However, the present study was implemented to overcome several weaknesses of the previous survey. First of all, within the past 5 yr, a significant number of new regional anesthesia techniques (posterior lumbar plexus block, 16,17 humeral block, 18 popliteal sciatic block 19) have entered the clinical scene, and the incidence and severity of complications that are associated with these techniques are largely unknown. Second, in France, the overall number of regional blocks has increased 12-fold in the last 16 yr. 20 Third, because complications were immediately declared by using the hotline, a detailed description of clinical situations could be obtained prospectively using a systematic questionnaire. The decision to consider a causal relation with regional anesthesia was thus made easier. Moreover, follow-up could be more complete.
Compared with our previous study, another difference is noteworthy: since the experts were available 24 h a day, it can be speculated that, in several circumstances, they influenced patient care and possibly helped improve outcome. Unfortunately, because of the study design, one cannot definitively prove this hypothesis. In the previous study, we could not ascertain that all of the blocks performed were declared in the booklets (leaving some doubt regarding the absolute validity of the denominator). The audit performed retrospectively in randomly chosen participants showed a very low level of underestimation, thus validating our denominator. We also could not be sure that all complications were reported (uncertainty for the numerator). However, we believe that the current design contributed to better reporting, because the participants often expressed their interest during the study. For example, participants often called the hotline because they were worried that they would not receive their next booklet in time to start the new 2-month period. One could suspect that the rate of complications for procedures performed by nonparticipating anesthesiologists is different from what we observed in our study population consisting of anesthesiologists who volunteered to participate in an audit on complications of regional anesthesia. It is possible that participating anesthesiologists might actually encounter fewer complications than nonparticipating anesthesiologists. The former are, indeed, more skilled and perform more blocks than the average French anesthesiologist (32.5/month vs. 17.3/month). 1,20,21 Incidentally, the participating anesthesiologists were more frequently employed in public hospitals (48%vs. 36%), but their mean age was not different (46 yr in both groups). Also, the causal link between a complication and regional anesthesia is sometimes difficult to establish. The risk of error was limited by immediate informal discussion among experts and formal analysis of all cases every 4 months in a joint meeting of experts. Moreover, external validation was obtained by comparing our conclusions on selected cases with those provided by three other experts. However, in a limited number of cases, the causal role of regional anesthesia could still not be determined. The main reasons for failure were (1) loss of follow-up and (2) electrophysiologic studies were not performed at all, were not performed on time, or were performed with a method not precise enough to make any valid conclusion.
The incidence of regional anesthesia-induced cardiac arrest may have been lower than what we found in our previous study. However, statistical tests were not applied because the data came from two different studies performed at different times with different anesthesiologists. Interestingly, however, the clinical situations in which cardiac arrests occurred were very similar and involved—in most cases, a central block performed during hip surgery in an elderly patient. We also recorded one case of cardiac arrest and two respiratory complications (not leading to cardiac arrest) that occurred during a lumbar plexus block performed via the posterior approach (incidence of severe complication, 80/10,000). These three complications were related to cephalad diffusion of the local anesthetic in the epidural or intrathecal space. 22 The lumbar blocks leading to severe complications had been performed by anesthesiologists trained in this technique. It is thus unlikely that technical factors played a prominent role. Although it is still too early to draw any definite conclusion regarding this block, anesthesiologists should be warned against the high rate of complications that was found with the posterior lumbar plexus block and should be advised to manage this block with at least the same vigilance as for a central block.
The incidence of systemic toxicity of local anesthetics and related seizures may also have been lower than in our previous report. Moreover, there were no cardiac arrests related to systemic toxicity. This low incidence of systemic complications may be related to better physician information and improved practice patterns (lower doses, slow injection, test dose, fractionated injection, and so forth). Although no local anesthetic-induced cardiac toxic event had been observed in our previous survey (at a time in which ropivacaine was not available in France), it is possible that the introduction of ropivacaine in clinical practice during this period has played a role, but this hypothesis cannot be verified using our methodology.
The incidence of neurologic complications after spinal anesthesia is higher with lidocaine than with bupivacaine. This supports the greater neurotoxicity of intrathecal lidocaine. 23–25 Neurologic complications also occurred after peripheral nerve blocks. One main reason to support the use of a nerve stimulator is the perceived reduction in the risk of nerve trauma. The present study was not designed to address this issue, and the use of a nerve stimulator was not specifically mentioned for each peripheral block performed. The exact incidence of neurologic complications after nerve stimulation (vs. other techniques) thus cannot be calculated. However, several complications occurred despite the use of a nerve stimulator. Inadequate patient positioning and/or noncooperative patients, insufficient physician experience, insufficient patient information on the procedure, excessive sedation, or a nongentle technique are critical factors that increase the risk of neurologic complications, and this is certainly also true when a nerve stimulator is used. Moreover, several anesthesiologists continue to mobilize their needle until they have a distinct distal muscular movement with a very low electrical intensity (< 0.5 mA), because it is widely believed that the lower the intensity required, the closer the needle from the nerve and thus the higher the success rate. Although there are, indeed, data to support this view, this remains a controversial issue, 26–28 and too small a distance between the needle and the nerve may in fact cause more harm than benefit. Further study is required to ascertain the role (or lack thereof) of these technical factors in the incidence of nerve injury during regional anesthesia.
In conclusion, this large-scale survey combining immediate declaration and analysis using a telephone hotline has allowed us to prospectively estimate the incidence of major complications after regional anesthesia. Several situations already known to be associated with an increased risk were identified (i.e., spinal anesthesia-induced cardiac arrest in the elderly or lidocaine toxicity after spinal injection). The major contribution is, however, the report of a high incidence of major complications after posterior lumbar plexus block and the occurrence of neurologic complications after the use of a nerve stimulator used for peripheral nerve blocks. A continuing survey will be useful because of the significant changes in practice that continue to occur.
The authors would like to thank Professor Francis Bonnet, M.D. (Chairman, Service d'Anesthésie-Réanimation Chirurgicale, Hôpital Tenon, Paris, France), Professor Jamil Hamza, M.D. (Chairman, Service d'Anesthésie et de Réanimation Chirurgicale, Hôpital Saint Vincent-de-Paul, Paris, France), and Louis-Jean Dupré, M.D. (Clinique Cleret, Chambéry, France), who acted as external experts. They also would like to thank all of the French anesthesiologists who participated for their enthusiasm and their constant help in the study process.
Table 5
Table 5
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Table 6
Table 6
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TABLETABLE
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Minerva Anestesiologica
One-day surgery for acquired forefoot deformity: sciatic nerve blockade with mepivacaine vs mepivacaine plus ropivacaine
Bugamelli, S; Zangheri, E; Montebugnoli, M; Borghi, B; Ricci, A; De Simone, N; Bonfatti, M; Elmar, K; Luppi, M; Pignotti, E
Minerva Anestesiologica, 73(): 57-64.

British Journal of Anaesthesia
Effects of ultrasound guidance on the minimum effective anaesthetic volume required to block the femoral nerve
Casati, A; Baciarello, M; Di Cianni, S; Danelli, G; De Marco, G; Leone, S; Rossi, M; Fanelli, G
British Journal of Anaesthesia, 98(6): 823-827.
10.1093/bja/aem100
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Regional Anesthesia and Pain Medicine
Anatomy and pathophysiology of spinal cord injury associated with regional anesthesia and pain medicine
Neal, JM
Regional Anesthesia and Pain Medicine, 33(5): 423-434.
10.1016/j.rapm.2006.10.014
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Regional Anesthesia and Pain Medicine
Adverse Outcomes Associated With Stimulator-Based Peripheral Nerve Blocks With Versus Without Ultrasound Visualization
Orebaugh, SL; Williams, BA; Vallejo, M; Kentor, ML
Regional Anesthesia and Pain Medicine, 34(3): 251-255.
10.1097/AAP.0b013e3181a3438e
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Anesthesia and Analgesia
The Effects of Ultrasound Guidance and Neurostimulation on the Minimum Effective Anesthetic Volume of Mepivacaine 1.5% Required to Block the Sciatic Nerve Using the Subgluteal Approach
Danelli, G; Ghisi, D; Fanelli, A; Ortu, A; Moschini, E; Berti, M; Ziegler, S; Fanelli, G
Anesthesia and Analgesia, 109(5): 1674-1678.
10.1213/ANE.0b013e3181b92372
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Journal of the American Academy of Orthopaedic Surgeons
Analgesia for total hip and knee arthroplasty: A multimodal pathway featuring peripheral nerve block
Horlocker, TT; Kopp, SL; Pagnano, MW; Hebl, JR
Journal of the American Academy of Orthopaedic Surgeons, 14(3): 126-135.

Anasthesiologie & Intensivmedizin
Hysterical paralysis - a rarely reported complication of regional anaesthesia: a case report
Besmer, I; Schupfer, G
Anasthesiologie & Intensivmedizin, 47(): 289-+.

Acta Anaesthesiologica Scandinavica
Major complications after 400 continuous popliteal sciatic nerve blocks for post-operative analgesia
Compere, V; Rey, N; Baert, O; Ouennich, A; Fourdrinier, V; Roussignol, X; Beccari, R; Dureuil, B
Acta Anaesthesiologica Scandinavica, 53(3): 339-345.
10.1111/j.1399-6576.2008.01849.x
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Phlebologie
Tumescent anaesthesia in combination with a femoral nerve block or a sciatic nerve block for surgery of varicose veins
Hillermann, T; Traber, J
Phlebologie, 38(3): 103-107.

Clinical Orthopaedics and Related Research
Does Regional Anesthesia Improve Outcome After Total Knee Arthroplasty?
Macfarlane, AJR; Prasad, GA; Chan, VWS; Brull, R
Clinical Orthopaedics and Related Research, 467(9): 2379-2402.
10.1007/s11999-008-0666-9
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Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
The network of regional anesthesia scientific working group. Regional anesthesia of DGAI and the BDA
Volk, T; Engelhardt, L; Spies, C; Steinfeldt, T; Kutter, B; Heller, A; Werner, C; Held, F; Burkle, H; Koch, T; Vicent, O; Geiger, P; Kessler, P; Wulf, H
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Regional Anesthesia and Pain Medicine
Prevention of Local Anesthetic Systemic Toxicity
Mulroy, MF; Hejtmanek, MR
Regional Anesthesia and Pain Medicine, 35(2): 177-180.
10.1097/AAP.0b013e3181d26068
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British Journal of Anaesthesia
Fifteen years of ultrasound guidance in regional anaesthesia: Part 1
Marhofer, P; Harrop-Griffiths, W; Kettner, SC; Kirchmair, L
British Journal of Anaesthesia, 104(5): 538-546.
10.1093/bja/aeq069
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Clinical Orthopaedics and Related Research
Complications of Femoral Nerve Block for Total Knee Arthroplasty
Sharma, S; Iorio, R; Specht, LM; Davies-Lepie, S; Healy, WL
Clinical Orthopaedics and Related Research, 468(1): 135-140.
10.1007/s11999-009-1025-1
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Regional Anesthesia and Pain Medicine
ASRA Practice Advisory on Local Anesthetic Systemic Toxicity
Neal, JM; Bernards, CM; Butterworth, JF; Di Gregorio, G; Drasner, K; Hejtmanek, MR; Mulroy, MF; Rosenquist, RW; Weinberg, GL
Regional Anesthesia and Pain Medicine, 35(2): 152-161.
10.1097/AAP.0b013e3181d22fcd
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Anaesthesia and Intensive Care
Perioperative epidural anaesthesia and analgesia - an appraisal of its role
Davies, MJ
Anaesthesia and Intensive Care, 35(4): 593-600.

British Journal of Anaesthesia
Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials
Fowler, SJ; Symons, J; Sabato, S; Myles, PS
British Journal of Anaesthesia, 100(2): 154-164.
10.1093/bja/aem373
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British Journal of Anaesthesia
Psoas compartment block for lower extremity surgery: a meta-analysis
Touray, ST; de Leeuw, MA; Zuurmond, WWA; Perez, RSGM
British Journal of Anaesthesia, 101(6): 750-760.
10.1093/bja/aen298
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Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Care for poly-traumas - Analgesia for cruciate ligament compensatory plastic of the knee
Neuburger, M; Buttner, O
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 42(): 732-737.

Chinese Medical Journal
Shenfu injection attenuates neurotoxicity of bupivacaine in cultured mouse spinal cord neurons
Xiong, LZ; Wang, Q; Liu, MY; Peng, Y; Li, QB; Lu, ZH; Lei, C
Chinese Medical Journal, 120(): 1958-1962.

Annales Francaises D Anesthesie Et De Reanimation
Ultrasound and regional anaesthesia
Delaunay, L; Plantet, F; Jochum, D
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10.1016/j.annfar.2008.12.013
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Annales Francaises D Anesthesie Et De Reanimation
About a neuropathy ...
Delaunay, L; Catoire, P; Estebe, JP; Gentili, M
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10.1016/j.annfar.2008.11.018
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Anesthesia and Analgesia
Regional Blockade in Patients with a History of a Seizure Disorder
Kopp, SL; Wynd, KP; Horlocker, TT; Hebl, JR; Wilson, JL
Anesthesia and Analgesia, 109(1): 272-278.
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Saudi Medical Journal
Complications related to regional anesthesia
Ornek, D; Erdogan, G; Horasanli, E; Cerit, N; Kalayci, D; Dikmen, B
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Anaesthesist
Abscess of the psoas muscle caused by a psoas compartment catheter. Case report of a rare complication of peripheral catheter regional anaesthesia
Neuburger, M; Lang, D; Buttner, J
Anaesthesist, 54(4): 341-345.
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Anesthesia and Analgesia
Signs of inflammation after sciatic nerve block in pigs
Voelckel, WG; Klima, G; Krismer, AC; Haslinger, C; Stadlbauer, KH; Wenzel, V; von Goedecke, A
Anesthesia and Analgesia, 101(6): 1844-1846.
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Urologia Internationalis
Lumbar plexus blockade with ropivacaine for postoperative pain management in elderly patients undergoing urologic surgeries
Akin, S; Aribogan, A; Turunc, T; Aridogan, A
Urologia Internationalis, 75(4): 345-349.
10.1159/000089172
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Regional Anesthesia and Pain Medicine
Nerve blocks at the wrist for carpal tunnel release revisited: The use of sensory-nerve and motor-nerve stimulation techniques
Macaire, P; Choquet, O; Jochum, D; Travers, V; Capdevila, X
Regional Anesthesia and Pain Medicine, 30(6): 536-540.
10.1016/j.rapm.2005.06.010
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Regional Anesthesia and Pain Medicine
Disclosure of risks associated with regional anesthesia: A survey of academic regional anesthesiologists
Brull, R; McCartney, CJL; Chan, VWS; Liguori, GA; Hargett, MJ; Xu, DQ; Abbas, S; El-Beheiry, H
Regional Anesthesia and Pain Medicine, 32(1): 7-11.
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Anaesthesia and Intensive Care
Long-term neurological complications associated with surgery and peripheral nerve blockade: outcomes after 1065 consecutive blocks
Watts, SA; Sharma, DJ
Anaesthesia and Intensive Care, 35(1): 24-31.

Regional Anesthesia and Pain Medicine
Preliminary Results of the Australasian Regional Anaesthesia Collaboration A Prospective Audit of More Than 7000 Peripheral Nerve and Plexus Blocks for Neurologic and Other Complications
Barrington, MJ; Watts, SA; Gledhill, SR; Thomas, RD; Said, SA; Snyder, GL; Tay, VS; Jamrozik, K
Regional Anesthesia and Pain Medicine, 34(6): 534-541.
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Regional Anesthesia and Pain Medicine
Regional Anaesthesia Adventures Carl Koller Lecture, ESRA 2008
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Intrathecal morphine vs psoas compartment block for hip surgery - Reply
Souron, V
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Regional Anesthesia and Pain Medicine
Lower-extremity peripheral nerve blockade: Essentials of our current understanding
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Regional Anesthesia and Pain Medicine
Neurotoxicity of intrathecally administered bupivacaine involves the posterior roots/posterior white matter and is milder than lidocaine in rats
Takenami, T; Yagishita, S; Murase, S; Hiruma, H; Kawakami, T; Hoka, S
Regional Anesthesia and Pain Medicine, 30(5): 464-472.
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Anesthesia and Analgesia
Thermographic temperature measurement compared with pinprick and cold sensation in predicting the effectiveness of regional blocks
Galvin, EM; Niehof, S; Medina, HJ; Zijlstra, FJ; van Bommel, J; Klein, J; Verbrugge, SJC
Anesthesia and Analgesia, 102(2): 598-604.
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British Journal of Anaesthesia
Perioperative cardiac arrest: a study of 53718 anaesthetics over 9 yr from a Brazilian teaching hospital
Braz, LG; Modolo, NSP; do Nascimento, P; Bruschi, BAM; Castiglia, YMM; Ganem, EM; de Carvalho, LR; Braz, JRC
British Journal of Anaesthesia, 96(5): 569-575.
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Acta Anaesthesiologica Scandinavica
Regional Anesthesia Surveillance System: first experiences with a quality assessment tool for regional anesthesia and analgesia
Schulz-Stubner, S; Kelley, J
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Anesthesia and Analgesia
The relationship between current intensity for nerve stimulation and success of peripheral nerve blocks performed in pediatric patients under general anesthesia
Gurnaney, H; Ganesh, A; Cucchiaro, G
Anesthesia and Analgesia, 105(6): 1605-1609.
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British Journal of Anaesthesia
International normalized ratio and prothrombin time values before the removal of a lumbar plexus catheter in patients receiving warfarin after total hip replacement
Chelly, JE; Szczodry, DM; Neumann, KJ
British Journal of Anaesthesia, 101(2): 250-254.
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Anaesthesist
Influence of blockades with local anesthetics on the stimulation ability of a nerve by peripheral nerve stimulation. Results of a randomized study
Neuburger, M; Gultlinger, O; Ass, B; Buttner, J; Kaiser, H
Anaesthesist, 54(6): 575-577.

Anasthesiologie & Intensivmedizin
Thromboembolyprophylase with peripheral blockade techniques to regional anasthesia
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Regional Anesthesia and Pain Medicine
Potential economic benefits of regional anesthesia for acute pain management: The need to study both inputs and outcomes
Williams, BA
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10.1016/j.rapm.2006.01.001
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Neurotoxicology
alpha-Lipoic acid prevents bupivacaine-induced neuron injury in vitro through a PI3K/Akt-dependent mechanism
Wang, XH; Zhang, XJ; Cheng, YL; Li, CF; Zhang, WB; Liu, L; Ding, ZN
Neurotoxicology, 31(1): 101-112.
10.1016/j.neuro.2009.10.010
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Journal of Bone and Joint Surgery-American Volume
Femoral Nerve Block for Diaphyseal and Distal Femoral Fractures in the Emergency Department
Mutty, CE; Jensen, EJ; Manka, MA; Anders, MJ; Bone, LB
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10.2106/JBJS.H.00314
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British Journal of Anaesthesia
Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data(dagger)
Popping, DM; Zahn, PK; Van Aken, HK; Dasch, B; Boche, R; Pogatzki-Zahn, EM
British Journal of Anaesthesia, 101(6): 832-840.
10.1093/bja/aen300
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Regional anesthesia and pre-existing neurological disease - II Reply
Dhir, S; Balasubramanian, S
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 55(): 876-877.

Regional Anesthesia and Pain Medicine
Upper Extremity Regional Anesthesia Essentials of Our Current Understanding, 2008
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Journal of Applied Physiology
Role of the hypoglossal nerve in equine nasopharyngeal stability
Cheetham, J; Pigott, JH; Hermanson, JW; Campoy, L; Soderholm, LV; Thorson, LM; Ducharme, NG
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Clinics
Mortality in Anesthesia: A Systematic Review
Braz, LG; Braz, DG; da Cruz, DS; Fernandes, LA; Modolo, NSP; Brazi, JRC
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Regional Anesthesia and Pain Medicine
Postoperative analgesia after total-hip arthroplasty: Comparison of intravenous patient-controlled analgesia with morphine and single injection of femoral nerve or psoas compartment block. A prospective, randomized, double-blind study
Biboulet, P; Morau, D; Aubas, P; Bringuier-Branchereau, S; Capdevila, X
Regional Anesthesia and Pain Medicine, 29(2): 102-109.
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British Journal of Anaesthesia
Location, location, location! Ultrasound imaging in regional anaesthesia
Denny, NA; Harrop-Griffiths, W
British Journal of Anaesthesia, 94(1): 1-3.
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Acta Anaesthesiologica Scandinavica
Inflammation and infection complications of 2285 perineural catheters: a prospective study
Neuburger, M; Buttner, J; Blumenthal, S; Breitbarth, J; Borgeat, A
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Anaesthesia and Intensive Care
Cardiac arrest during continuous psoas compartment block for hip surgery
Zanette, G; Robb, N; Micaglio, M; Manani, G; Facco, E
Anaesthesia and Intensive Care, 35(1): 143-144.

Anaesthesia and Intensive Care
Safety of the psoas compartment block?
Cattano, D
Anaesthesia and Intensive Care, 35(4): 615-616.

Annales Francaises D Anesthesie Et De Reanimation
Peripheral neuropathy after lumbar plexus block achieved under general anesthesia
Mounir, K; Elwali, A; Bensghir, M; Belyamani, L; Atmani, M; Kamili, ND
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Pediatric Anesthesia
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Anaesthesia and Intensive Care
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Zanette, G
Anaesthesia and Intensive Care, 35(4): 615.

Acta Anaesthesiologica Scandinavica
Nosocomial infections and infection control in regional anesthesia
Schulz-Stubner, S; Pottinger, JM; Coffin, SA; Herwaldt, LA
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Signa Vitae
Perioperative Cardiac Arrests
Sprung, J; Flick, RP; Gleich, SJ; Weingarten, TN
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Enfermedades Infecciosas Y Microbiologia Clinica
Streptococcus salivarus meningitis following subarachnoid anesthesia
Cervero, M
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Anesthesia and Analgesia
Seizure after levobupivacaine for interscalene brachial plexus block
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Anaesthesia
Levobupivacaine-induced seizures and cardiovascular collapse treated with Intralipid (R)
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Regional Anesthesia and Pain Medicine
Does a Paresthesia During Spinal Needle Insertion Indicate Intrathecal Needle Placement?
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Annales Francaises D Anesthesie Et De Reanimation
Immunoallergic transitory paraplegia after regional anaesthesia
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Regional Anesthesia and Pain Medicine
Safety During Regional Anesthesia What Do We Know and How Can We Improve Our Practice?
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Regional Anesthesia and Pain Medicine
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Regional Anesthesia and Pain Medicine
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Regional Anesthesia and Pain Medicine
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Journal of Arthroplasty
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
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Thrombosis and Haemostasis
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Anesthesia and Analgesia
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Regional Anesthesia and Pain Medicine
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Annales Francaises D Anesthesie Et De Reanimation
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Anesthesia and Analgesia
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Surgical Clinics of North America
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Anesthesia and Analgesia
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Anaesthesist
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Anaesthesia
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Regional Anesthesia and Pain Medicine
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Regional Anesthesia and Pain Medicine
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Anesthesia and Analgesia
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Anaesthesist
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Anesthesia and Analgesia
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Anesthesia and Analgesia, 107(5): 1458-1460.
10.1213/ane.0b013e318189476b
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British Journal of Anaesthesia
Ultrasound provides a reliable test of local anaesthetic spread during performance of peripheral nerve blocks
McCartney, CJL; Dickinson, V; Dubrowski, A; Riazi, S; McHardy, P; Awad, I
British Journal of Anaesthesia, 102(4): 583.

Anaesthesist
Peripheral nerve blocks of the lower extremities
Reske, AW; Reske, AP; Meier, V; Wiegel, M
Anaesthesist, 58(): 1055-1070.
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Anesthesia and Analgesia
Continuous peripheral neural blockade for postoperative analgesia: Practical advantages
Ben-David, B; Chelly, JE
Anesthesia and Analgesia, 96(5): 1537.
10.1213/01.ANE.0000063170.15467.F2
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
The radial nerve should be blocked before the ulnar nerve during a brachial plexus block at the humeral canal
Guntz, E; Herman, P; Delbos, A; Sosnowski, M
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 51(4): 354-357.

Journal of Cardiothoracic and Vascular Anesthesia
The effects of intrathecal morphine on patients undergoing minimally invasive direct coronary artery bypass surgery
Zisman, E; Shenderey, A; Ammar, R; Eden, A; Pizov, R
Journal of Cardiothoracic and Vascular Anesthesia, 19(1): 40-43.
10.1053/j.jvca.2004.11.007
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Advances in Therapy
Efficacy of thoracic epidural analgesia for laparoscopic cholecystectomy
Erol, DD; Yilmaz, S; Polat, C; Arikan, Y
Advances in Therapy, 25(1): 45-52.
10.1007/s12325-008-0005-2
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Neuroscience
Dexamethasone Attenuated Bupivacaine-Induced Neuron Injury in Vitro Through A Threonine-Serine Protein Kinase B-Dependent Mechanism
Ma, R; Wang, X; Lu, C; Li, C; Cheng, Y; Ding, G; Liu, L; Ding, Z
Neuroscience, 167(2): 329-342.
10.1016/j.neuroscience.2009.12.049
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Anesthesia and Analgesia
In with the new, out with the old? Comparison of two approaches for psoas compartment block
Mannion, S; O'Callaghan, S; Walsh, M; Murphy, DB; Shorten, GD
Anesthesia and Analgesia, 101(1): 259-264.
10.1213/01.ANE.0000153866.38440.43
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Anesthesia and Analgesia
Intraarticular bupivacaine-clonidine-morphine versus femoral-sciatic nerve block in pediatric patients undergoing anterior cruciate ligament reconstruction
Tran, KM; Ganley, TJ; Wells, L; Ganesh, A; Minger, KI; Cucchiaro, G
Anesthesia and Analgesia, 101(5): 1304-1310.
10.1213/01.ANE.0000180218.54037.0B
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Epidural hematoma after hemorrhagic shock in a parturient
Nguyen, L; Riu, M; Minville, V; Chassery, C; Catalaa, I; Samii, K
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 53(3): 252-257.

Anesthesia and Analgesia
An ultrasonographic and histological study of intraneural injection and electrical stimulation in pigs
Chan, VWS; Brull, R; McCartney, CJL; Xu, DQ; Abbas, S; Shannon, P
Anesthesia and Analgesia, 104(5): 1281-1284.
10.1213/01.ane.0000250915.45247.24
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Acta Anaesthesiologica Scandinavica
Ultrasound controlled nerve stimulation in the elbow region: high currents and short distances needed to obtain motor responses
Sauter, AR; Dodgson, MS; Stubhaug, A; Cvancarova, M; Klaastad, O
Acta Anaesthesiologica Scandinavica, 51(7): 942-948.
10.1111/j.1399-6576.2007.01349.x
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Anesthesia and Analgesia
The safety and efficacy of extended thromboprophylaxis with fondaparinux after major orthopedic surgery of the lower limb with or without a neuraxial or deep peripheral nerve catheter: The EXPERT study
Singelyn, FJ; Verheyen, CCPM; Piovella, F; Van Aken, HK; Rosencher, N
Anesthesia and Analgesia, 105(6): 1540-1547.
10.1213/01.ane.0000287677.95626.60
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Anesthesia and Analgesia
Successful resuscitation after ropivacaine and lidocaine-induced ventricular arrhythmia following posterior lumbar plexus block in a child
Ludot, H; Tharin, JY; Belouadah, M; Mazoit, JX; Malinovsky, JM
Anesthesia and Analgesia, 106(5): 1572-1574.
10.1213/01.ane.0000286176.55971.f0
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Acta Anaesthesiologica Scandinavica
Ultrasound-guided peripheral nerve blocks: What are the benefits?
Koscielniak-Nielsen, ZJ
Acta Anaesthesiologica Scandinavica, 52(6): 727-737.
10.1111/j.1399-6576.2008.01666.x
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Acta Anaesthesiologica Scandinavica
Ultrasound-guided technique allowed early detection of intravascular injection during an infraclavicular brachial plexus block
Navas, AM; Gonzalez, ROD
Acta Anaesthesiologica Scandinavica, 53(7): 968-970.
10.1111/j.1399-6576.2009.01981.x
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Regional Anesthesia and Pain Medicine
An Animal Model of "Syringe Feel" During Peripheral Nerve Block
Theron, PS; Mackay, Z; Gonzalez, JG; Donaldson, N; Blanco, R
Regional Anesthesia and Pain Medicine, 34(4): 330-332.
10.1097/AAP.0b013e3181ac7f38
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Anesthesia and Analgesia
Adding a selective obturator nerve block to the parasacral sciatic nerve block: An evaluation
Jochum, D; Iohom, G; Choquet, O; Macalou, D; Ouologuem, S; Meuret, P; Kayembe, F; Heck, M; Mertes, PM; Bouaziz, H
Anesthesia and Analgesia, 99(5): 1544-1549.
10.1213/01.ANE.0000136464.86801.EE
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Annales Francaises D Anesthesie Et De Reanimation
Prolonged asystole after spinal anesthesia in a patient with Gallavardin's syndrome
Quiniou, C; Pandin, P; Renard, A; Lambert, A; Vandesteene, A
Annales Francaises D Anesthesie Et De Reanimation, 23(8): 822-826.
10.1016/j.annfar.2004.05.014
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Anaesthesist
Survey on current practice of regional anaesthesia in Germany, Austria, and Switzerland. Part 2: Use, success rates and techniques
Grau, T; Fatehi, S; Motsch, J; Bartusseck, E
Anaesthesist, 53(9): 847-855.
10.1007/s00101-004-0720-2
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Anaesthesia and Intensive Care
Re: Cardiac arrest during continuous psoas compartment block for hip surgery
Peady, CJ
Anaesthesia and Intensive Care, 35(4): 615.

Anasthesiologie & Intensivmedizin
The controllability of local anaesthetic spread during spinal anaesthesia-still a challenge?
Litz, RJ; Koch, T
Anasthesiologie & Intensivmedizin, 48(): 404-415.

Anesthesia and Analgesia
Accidental intraneural injection into the musccutaneous nerve visualized with ultrasound
Russon, K; Blanco, R
Anesthesia and Analgesia, 105(5): 1504-1505.
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Anesthesia and Analgesia
In vitro, inhibition of mitogen-activated protein kinase pathways protects against bupivacaine- and ropivacaine-induced neurotoxicity
Lirk, P; Haller, I; Colvin, HP; Lang, L; Tomaselli, B; Klimaschewski, L; Gerner, P
Anesthesia and Analgesia, 106(5): 1456-1464.
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Anaesthesist
Analgesia in major knee surgery - Epidural analgesia compared to peripheral nerve blockade
Thil, O; Kleinschmidt, S
Anaesthesist, 57(8): 817-818.
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Regional Anesthesia and Pain Medicine
Practice patterns related to block selection, nerve localization and risk disclosure: A survey of the American Society of Regional Anesthesia and Pain Medicine
Brull, R; Wijayatilake, DS; Perlas, A; Chan, VWS; Abbas, S; Liguori, GA; Hargett, MJ; EI-Beheiry, H
Regional Anesthesia and Pain Medicine, 33(5): 395-403.
10.1016/j.rapm.2008.02.007
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Regional Anesthesia and Pain Medicine
ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine
Neal, JM; Bernards, CM; Hadzic, A; Hebl, JR; Hogan, QH; Horlocker, TT; Lee, LA; Rathmell, JP; Sorenson, EJ; Suresh, S; Wedel, DJ
Regional Anesthesia and Pain Medicine, 33(5): 404-415.
10.1016/j.rapm.2008.07.527
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Regional Anesthesia and Pain Medicine
Regional anesthesia in anesthetized or heavily sedated patients
Bernards, CM; Hadzic, A; Suresh, S; Neal, JM
Regional Anesthesia and Pain Medicine, 33(5): 449-460.
10.1016/j.rapm.2008.07.529
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Orthopade
Pain therapy for the lower extremities
Simanski, CJP
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Proceedings of the 7Th Biennial Congress Asian & Oceanic Society of Regional Anesthesia & Pain Medicine
Promoting regional anesthesia and pain medicine: The North American experience
Horlocker, TT
Proceedings of the 7Th Biennial Congress Asian & Oceanic Society of Regional Anesthesia & Pain Medicine, (): 69-72.

Scandinavian Journal of Infectious Diseases
Fatal bacterial meningitis after spinal anaesthesia
Halaby, T; Leyssius, A; Veneman, T
Scandinavian Journal of Infectious Diseases, 39(3): 280-283.
10.1080/00365540600951309
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Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Combined spinal epidural anesthetic for treatment of pain
Standl, T
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Annales Francaises D Anesthesie Et De Reanimation
Paraplegia after spinal anaesthesia at a patient presenting a degenerative lumbar spinal disease
Maman, AFOB; Tomta, K; Songne, B; Moumouni, I; Abalo, A
Annales Francaises D Anesthesie Et De Reanimation, 26(5): 465-466.
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Anaesthesia
Epidural haematomas
Swinton, F; Schuster-Bruce, M
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Regional Anesthesia and Pain Medicine
Posterior lumbar plexus block in children: A new anatomical landmark
Mello, SS; Saraiva, RA; Marques, RS; Gasparini, JR; Assis, CN; Goncalves, MHL
Regional Anesthesia and Pain Medicine, 32(6): 522-527.
10.1016/j.rapm.2007.06.395
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Regional Anesthesia and Pain Medicine
Effects of using the posterior or anterior approaches to the lumbar plexus on the minimum effective anesthetic concentration (MEAC) of mepivacaine required to block the femoral nerve: A prospective, randomized, up-and-down study
Cappelleri, G; Aldegheri, G; Ruggieri, F; Carnelli, F; Fanelli, A; Casati, A
Regional Anesthesia and Pain Medicine, 33(1): 10-16.
10.1016/j.rapm.2007.07.008
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Regional Anesthesia and Pain Medicine
Synovial cysts and the lithotomy position causing cauda equina syndrome
Wills, JH; Wiesel, S; Abram, SE; Rupp, FW
Regional Anesthesia and Pain Medicine, 29(3): 234-236.
10.1016/j.rapm.2004.01.015
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Anesthesia and Analgesia
Cardiac arrest during neuraxial anesthesia: Frequency and predisposing factors associated with survival
Kopp, SL; Horlocker, TT; Warner, ME; Hebl, JR; Vachon, CA; Schroeder, DR; Gould, AB; Sprung, J
Anesthesia and Analgesia, 100(3): 855-865.
10.1213/01.ANE.0000144066.72932.B1
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Anesthesia and Analgesia
Neurologic complication after anterior sciatic nerve block
Shah, S; Hadzic, A; Vloka, JD; Cafferty, MS; Moucha, CS; Santos, AC
Anesthesia and Analgesia, 100(5): 1515-1517.
10.1213/01.ANE.0000150613.23987.92
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British Journal of Anaesthesia
Thigh abscess as a complication of continuous popliteal sciatic nerve block
Compere, V; Cornet, C; Fourdrinier, V; Maitre, AM; Mazirt, N; Biga, N; Dureuil, B
British Journal of Anaesthesia, 95(2): 255-256.
10.1093/bja/aei164
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Anaesthesist
Psychological traits, course of surgery and recovery following hernia repair in patients preferring general or local anaesthesia
Mullender, A; Melichar, G; Schmucker, P; Huppe, M
Anaesthesist, 55(3): 247-254.
10.1007/s00101-005-0917-z
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Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Epidural anaesthetic - Step by step to success
Standl, T; Gottschalk, A
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 42(2): 90-99.

Anaesthesist
Electrical nerve stimulation for plexus and nerve blocks
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Journal of Clinical Anesthesia
Comparison of spinal anesthesia with combined sciatic-femoral nerve block for outpatient knee arthroscopy
Montes, FR; Zarate, E; Grueso, R; Giraldo, JC; Venegas, MP; Gomez, A; Rincon, JD; Hernadez, M; Cabrera, M
Journal of Clinical Anesthesia, 20(6): 415-420.
10.1016/j.jclinane.2008.04.003
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Regional anesthesia and pre-existing neurological disease - I
Macfarlane, AJR; Brull, R
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 55(): 875.

Regional Anesthesia and Pain Medicine
Ultrasound-Guided Regional Anesthesia and Analgesia A Qualitative Systematic Review
Liu, SS; Ngeow, JE; YaDeau, JT
Regional Anesthesia and Pain Medicine, 34(1): 47-59.
10.1097/AAP.0b013e3181933ec3
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European Journal of Pain
Regional anaesthesia and side effects: is it safe?
Allegri, M; Grossi, P; Ferrari, F; Borghi, B
European Journal of Pain, (): 31-35.

Anesthesia and Analgesia
Spinal anesthesia performance conditions and side effects are comparable between the newly designed ballpen and the sprotte needle: Results of a prospective comparative randomized multicenter study
Standl, T; Stanek, A; Burmeister, MA; Gruschow, S; Wahlen, B; Muller, K; Biscoping, J; Adams, HA
Anesthesia and Analgesia, 98(2): 512-517.
10.1213/01.ANE.0000097183.93259.74
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Surgical and Radiologic Anatomy
Anatomical basis for ultrasound-guided regional anaesthesia at the junction of the axilla and the upper arm
Berthier, F; Lepage, D; Henry, Y; Vuillier, F; Christophe, JL; Boillot, A; Samain, E; Tatu, L
Surgical and Radiologic Anatomy, 32(3): 299-304.
10.1007/s00276-009-0539-2
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Anaesthesia and Intensive Care
Regional anaesthesia for bilateral upper limb surgery: a review of challenges and solutions
Holborow, J; Hocking, G
Anaesthesia and Intensive Care, 38(2): 250-258.

Anasthesiologie & Intensivmedizin
Regional anaesthesia in patients with anticoagulative therapy
Neuburger, M; Buttner, J
Anasthesiologie & Intensivmedizin, 48(): S159-S162.

Anaesthesist
Complications and adverse events in continuous peripheral regional anesthesia. Results of investigations on 3,491 catheters
Neuburger, M; Breitbarth, J; Reisig, F; Lang, D; Buttner, J
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Progres En Urologie
Urological management of neurogenic bladder - Introduction
Chartier-Kastler, E; Ruffion, A
Progres En Urologie, 17(3): 325-+.

Journal of Shoulder and Elbow Surgery
Indwelling interscalene catheter use in an outpatient setting for shoulder surgery: Technique, efficacy, and complications
Bryan, NA; Swenson, JD; Greis, PE; Burks, RT
Journal of Shoulder and Elbow Surgery, 16(4): 388-395.
10.1016/j.jse.2006.10.012
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Regional Anesthesia and Pain Medicine
Ultrasound guidance with nerve stimulation reduces the time necessary for resident peripheral nerve blockade
Orebaugh, SL; Williams, BA; Kentor, ML
Regional Anesthesia and Pain Medicine, 32(5): 448-454.
10.1016/j.rapm.2007.05.004
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Journal of Clinical Anesthesia
Comparison of sciatic psoas compartment block and sciatic femoral 3-in-1 block for knee arthroscopy
Atim, A; Ergin, A; Kurt, E; Ozdemiroglu, Y; Guzeldemir, E
Journal of Clinical Anesthesia, 19(8): 591-595.
10.1016/j.jclinane.2007.06.014
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Regional Anesthesia and Pain Medicine
Evaluation of magnetic resonance imaging following neuraxial steroid administration: Does epidural injection produce pathologic findings?
Davidson, EM; Sklar, EM; Ginosar, Y; Abdi, S; Bhatia, RG; Garcia, L; Hulen, RB; Arheart, KL; Birnbach, DJ
Regional Anesthesia and Pain Medicine, 33(4): 326-331.
10.1016/j.rapm.2008.01.014
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Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Regional anesthesia and pre-existing neurological disease - II Reply
Guay, J
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Knee
Femoral nerve block for total knee replacement - A word of caution
Kandasami, M; Kinninmonth, AWG; Sarungi, M; Baines, J; Scott, NB
Knee, 16(2): 98-100.
10.1016/j.knee.2008.10.007
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Drug Safety
Adverse Drug Reactions to Local Anaesthetics A Review of the French Pharmacovigilance Database
Fuzier, R; Lapeyre-Mestre, M; Samii, K; Montastruc, JL
Drug Safety, 32(4): 345-356.

Annales Francaises D Anesthesie Et De Reanimation
Mitochondria in anaesthesia and intensive care
Nouette-Gaulain, K; Quinart, A; Letellier, T; Sztark, F
Annales Francaises D Anesthesie Et De Reanimation, 26(4): 319-333.
10.1016/j.annfar.2007.01.012
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Annales Francaises D Anesthesie Et De Reanimation
Psoas compartment block with general anaesthesia: descriptive study of 93 cases
Destrube, M; Guillou, N; Orain, C; Chaillou, M; Ecoffey, C
Annales Francaises D Anesthesie Et De Reanimation, 26(5): 418-422.
10.1016/j.annfar.2007.03.012
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Minerva Anestesiologica
An unusual cause of seizures during subarachnoid anesthesia in a patient undergoing transurethral resection of the prostate: a case report
Galante, D
Minerva Anestesiologica, 75(4): 221-223.

Chinese Medical Journal
Cauda equina syndrome: a review of clinical progress
Ma, B; Wu, H; Jia, LS; Yuan, W; Shi, GD; Shi, JG
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Regional Anesthesia and Pain Medicine
Effects of epinephrine in local anesthetics on the central and peripheral nervous systems: Neurotoxicity and neural blood flow
Neal, JM
Regional Anesthesia and Pain Medicine, 28(2): 124-134.
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Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Anaesthesia today
Blobner, M; Kochs, E
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 38(4): 241-254.

Cochrane Database of Systematic Reviews
Ultrasound guidance for peripheral nerve blockade
Walker, KJ; McGrattan, K; Aas-Eng, K; Smith, AF
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European Review for Medical and Pharmacological Sciences
Anaesthesia for total knee arthroplasty: efficacy of single-injection or continuous lumbar plexus associated with sciatic nerve blocks - A randomized controlled study
Frassanito, L; Vergari, A; Messina, A; Pitoni, S; Puglisi, C; Chierichini, A
European Review for Medical and Pharmacological Sciences, 13(5): 375-382.

Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Case report: Neurological deficit associated with intraneural needle placement without injection
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Regional Anesthesia and Pain Medicine
Can we consider the psoas compartment block a reliable one?
Al Nasser, B
Regional Anesthesia and Pain Medicine, 29(2): 172.
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Anesthesia and Analgesia
Ultrasound-guided regional anesthesia: In search of the holy grail
Horlocker, TT; Wedel, DJ
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Anesthesia and Analgesia
Ultrasound-guided regional anesthesia: Current concepts and future trends
Marhofer, P; Chan, VWS
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Journal of Bone and Joint Surgery-American Volume
Femoral nerve block for diaphyseal and distal femoral fractures in the emergency department
Mutty, CE; Jensen, EJ; Manka, MA; Anders, MJ; Bone, LB
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Anaesthesia, Pain, Intensive Care and Emergency: A.P.I.C.E
Side effects induced by anaesthetic manipulation or by surgical operation
Leykin, Y; Noal, N
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Annales Francaises D Anesthesie Et De Reanimation
Interscalene brachial plexus block for glenohumeral luxation in prehospital medicine
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Clinical Orthopaedics and Related Research
Functional Outcome of Femoral versus Obturator Nerve Block after Total Knee Arthroplasty
Bergeron, SG; Kardash, KJ; Huk, OL; Zukor, DJ; Antoniou, J
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Anesthesia and Analgesia
Neuraxial Techniques in Obstetric and Non-Obstetric Patients with Common Bleeding Diatheses
Choi, S; Brull, R
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British Journal of Anaesthesia
Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review
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Journal of Neuroscience Research
Hyperglycemia magnifies bupivacaine-induced cell apoptosis triggered by mitochondria dysfunction and endoplasmic reticulum stress
Li, L; Ye, XP; Lu, AZ; Zhou, SQ; Liu, H; Liu, ZJ; Jiang, S; Xu, SY
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Knee
Pain control after primary total knee replacement. A prospective randomised controlled trial of local infiltration versus single shot femoral nerve block
Ashraf, A; Raut, VV; Canty, SJ; McLauchlan, GJ
Knee, 20(5): 324-327.
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Anaesthesia
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Whittaker, S; Lethbridge, G; Kim, C; Cohen, ZK; Ng, I
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British Journal of Anaesthesia
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Mokini, Z; Buccino, C; Vitale, G; Mauri, T; Fumagalli, R; Pesenti, A
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Anaesthesist
Successful infection control in regional anesthesia procedures. Observational survey after introduction of the DGAI hygiene recommendations
Reisig, F; Neuburger, M; Zausig, YA; Graf, BM; Buttner, J
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International Journal of Obstetric Anesthesia
A qualitative analysis of parturients' perspectives on neuraxial labor analgesia
Toledo, P; Sun, J; Peralta, F; Grobman, WA; Wong, CA; Hasnain-Wynia, R
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Acta Anaesthesiologica Scandinavica
Serious complications associated with spinal and epidural anaesthesia in Finland from 2000 to 2009
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Hip International
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American Journal of Therapeutics
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Anesthesiology
Learning from Incidents and Near-misses Reports
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Retigabine Stimulates Human KCNQ2/Q3 Channels in the Presence of Bupivacaine
Punke, MA; Friederich, P
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Anesthesiology
Continuous Peripheral Nerve Blocks: Fewer Excuses
Klein, SM
Anesthesiology, 103(5): 921-923.

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Anesthesiology
Quantitative Architecture of the Brachial Plexus and Surrounding Compartments, and Their Possible Significance for Plexus Blocks
Moayeri, N; Bigeleisen, PE; Groen, GJ
Anesthesiology, 108(2): 299-304.
10.1097/01.anes.0000299433.25179.70
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Ultrasound Guidance for Axillary Plexus Block Does Not Prevent Intravascular Injection
Zetlaoui, PJ; Labbe, J; Benhamou, D
Anesthesiology, 108(4): 761.
10.1097/ALN.0b013e3181684c0f
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Lumbar Plexus Block Using High-pressure Injection Leads to Contralateral and Epidural Spread
Gadsden, JC; Lindenmuth, DM; Hadzic, A; Xu, D; Somasundarum, L; Flisinski, KA
Anesthesiology, 109(4): 683-688.
10.1097/ALN.0b013e31818631a7
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Anesthesiology
Incidence of Epidural Hematoma, Infection, and Neurologic Injury in Obstetric Patients with Epidural Analgesia/Anesthesia
Ruppen, W; Derry, S; McQuay, H; Moore, RA
Anesthesiology, 105(2): 394-399.

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Anesthesiology
What Has Happened to Evidence-based Medicine?
Weller, R; Gerancher, JC; Crews, JC; Wade, KL
Anesthesiology, 99(4): 1029.

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Severe Neurological Complications after Central Neuraxial Blockades in Sweden 1990–1999
Moen, V; Dahlgren, N; Irestedt, L
Anesthesiology, 101(4): 950-959.

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Anesthesiology
Nerve Puncture and Apparent Intraneural Injection during Ultrasound-guided Axillary Block Does Not Invariably Result in Neurologic Injury
Bigeleisen, PE
Anesthesiology, 105(4): 779-783.

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Anesthesiology
Efficacy of Postoperative Patient-controlled and Continuous Infusion Epidural Analgesia versus Intravenous Patient-controlled Analgesia with Opioids: A Meta-analysis
Wu, CL; Cohen, SR; Richman, JM; Rowlingson, AJ; Courpas, GE; Cheung, K; Lin, EE; Liu, SS
Anesthesiology, 103(5): 1079-1088.

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Anesthesiology
Is Low-current Search a Risk Factor in Peripheral Nerve Localization?
Capdevila, X; Choquet, O
Anesthesiology, 104(6): 1348.

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Anesthesiology
Author Corrections
,
Anesthesiology, 98(2): 595.

Anesthesiology
Continuous Peripheral Nerve Blocks in Hospital Wards after Orthopedic Surgery: A Multicenter Prospective Analysis of the Quality of Postoperative Analgesia and Complications in 1,416 Patients
Capdevila, X; Pirat, P; Bringuier, S; Gaertner, E; Singelyn, F; Bernard, N; Choquet, O; Bouaziz, H; Bonnet, F; the French Study Group on Continuous Peripheral Nerve Blocks,
Anesthesiology, 103(5): 1035-1045.

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Anesthesiology
Post–Dural Puncture Bacterial Meningitis
Baer, ET
Anesthesiology, 105(2): 381-393.

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Anesthesiology
Procaine Spinal Neurotoxicity
Johnson, ME; Swanson, JW
Anesthesiology, 109(2): 349-351.
10.1097/ALN.0b013e31817fdeb8
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Anesthesiology
Effects of Intermittent Femoral Nerve Injections of Bupivacaine, Levobupivacaine, and Ropivacaine on Mitochondrial Energy Metabolism and Intracellular Calcium Homeostasis in Rat Psoas Muscle
Nouette-Gaulain, K; Sirvent, P; Canal-Raffin, M; Morau, D; Malgat, M; Molimard, M; Mercier, J; Lacampagne, A; Sztark, F; Capdevila, X
Anesthesiology, 106(5): 1026-1034.
10.1097/01.anes.0000265164.29630.b4
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Anesthesiology
Can We Explain the High Incidence of Cardiac Arrest during Spinal Anesthesia for Hip Surgery?
Pollard, JB
Anesthesiology, 99(3): 754-755.

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Anesthesiology
Mitochondrial Injury and Caspase Activation by the Local Anesthetic Lidocaine
Johnson, ME; Uhl, CB; Spittler, K; Wang, H; Gores, GJ
Anesthesiology, 101(5): 1184-1194.

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Anesthesiology
Predictors of Survival following Cardiac Arrest in Patients Undergoing Noncardiac Surgery: A Study of 518,294 Patients at a Tertiary Referral Center
Sprung, J; Warner, ME; Contreras, MG; Schroeder, DR; Beighley, CM; Wilson, GA; Warner, DO
Anesthesiology, 99(2): 259-269.

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Anesthesiology
Psoas Abscess Complicating Femoral Nerve Block Catheter
Adam, F; Jaziri, S; Chauvin, M
Anesthesiology, 99(1): 230-231.

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Anesthesiology
Injuries Associated with Regional Anesthesia in the 1980s and 1990s: A Closed Claims Analysis
Lee, LA; Posner, KL; Domino, KB; Caplan, RA; Cheney, FW
Anesthesiology, 101(1): 143-152.

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Critical Care Medicine
Regional analgesia in the critically ill
Schulz-Stübner, S; Boezaart, A; Hata, JS
Critical Care Medicine, 33(6): 1400-1407.
10.1097/01.CCM.0000165843.39713.AE
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Critical Care Medicine
The evolution of pain management in the critically ill trauma patient: Emerging concepts from the global war on terrorism
Malchow, RJ; Black, IH
Critical Care Medicine, 36(7): S346-S357.
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Current Opinion in Anesthesiology
Epidemiology and morbidity of regional anaesthesia in children
Lacroix, F
Current Opinion in Anesthesiology, 21(3): 345-349.
10.1097/ACO.0b013e3282ffabc5
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Current Opinion in Anesthesiology
Continuous peripheral nerve blockade for postoperative analgesia
Le-Wendling, L; Enneking, FK
Current Opinion in Anesthesiology, 21(5): 602-609.
10.1097/ACO.0b013e32830a4be6
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Current Opinion in Critical Care
Cardiac arrest during anesthesia
Zuercher, M; Ummenhofer, W
Current Opinion in Critical Care, 14(3): 269-274.
10.1097/MCC.0b013e3282f948cd
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European Journal of Anaesthesiology (EJA)
The sciatic nerve should be blocked to optimize postoperative analgesia after knee arthroplasty
Aguirre, J; Neudoerfer, C; Ekatodramis, G; Borgeat, A
European Journal of Anaesthesiology (EJA), 26(5): 439-440.
10.1097/EJA.0b013e32831bc654
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European Journal of Anaesthesiology (EJA)
Current practice in regional anaesthesia in Germany
Heid, F; Jage, B; Jage, J
European Journal of Anaesthesiology (EJA), 23(4): 346-350.
10.1017/S0265021505001948
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European Journal of Anaesthesiology (EJA)
Differential neurotoxicity of tricyclic antidepressants and novel derivatives in vitro in a dorsal root ganglion cell culture model*
Haller, I; Lirk, P; Keller, C; Wang, GK; Gerner, P; Klimaschewski, L
European Journal of Anaesthesiology (EJA), 24(8): 702-708.
10.1017/S0265021507000154
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Journal of Neurosurgical Anesthesiology
Neurotoxicity of Lidocaine: Implications for Spinal Anesthesia and Neuroprotection
Johnson, ME
Journal of Neurosurgical Anesthesiology, 16(1): 80-83.

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Simulation in Healthcare
Management of Profound Hypotension Secondary to Spinal Anesthesia: Simulation Case Scenario
McIvor, WR; Olutunmbi, Y; Borrell, J
Simulation in Healthcare, 5(1): 61-64.
10.1097/SIH.0b013e3181c75fac
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