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    <title><![CDATA[Regional Anesthesia and Pain Medicine - Most Popular Articles]]></title>
    <link>http://journals.lww.com/rapm/pages/viewallmostpopulararticles.aspx</link>
    <description><![CDATA[Regional Anesthesia and Pain Medicine, official publication of the American Society of Regional Anesthesia and Pain Medicine, is a bimonthly journal that publishes peer-reviewed scientific and clinical studies to advance the understanding and clinical application of regional techniques for surgical anesthesia and postoperative analgesia. Coverage includes perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications. Practical issues such as choice of anesthetics and technical challenges are addressed. The journal has a special interest in all forms of research pertaining to ultrasound-guided regional anesthesia and to education in regional anesthesia and pain medicine. Published for over thirty years, this respected journal also serves as the official publication of ASRA’s affiliates, the European Society of Regional Anaesthesia and Pain Therapy, the Asian and Oceanic Society of Regional Anesthesia, and the Latin American Society of Regional Anesthesia.]]></description>
    <language>en-us</language>
    <lastBuildDate>Sun, 22 Nov 2009 17:11:13 -0600</lastBuildDate>
    <generator>Wolters Kluwer Health RSS Generator</generator>
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      <url>http://images.journals.lww.com/rapm/XLargeThumb.00115550-200911000-00000.CV.jpeg</url>
      <title><![CDATA[Regional Anesthesia and Pain Medicine - Most Popular Articles]]></title>
      <link>http://journals.lww.com/rapm/pages/viewallmostpopulararticles.aspx</link>
    </image>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/01000/The_American_Society_of_Regional_Anesthesia_and.11.aspx</link>
      <author>Sites, Brian D.; Chan, Vincent W.; Neal, Joseph M.; Weller, Robert; Grau, Thomas; Koscielniak-Nielsen, Zbigniew J.; Ivani, Giorgio</author>
      <category>Special Article</category>
      <title><![CDATA[The American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy Joint Committee Recommendations for Education and Training in Ultrasound-Guided Regional Anesthesia]]></title>
      <description><![CDATA[Ultrasound-guided regional anesthesia (UGRA) is a growing area of both clinical and research interest. The following document contains the work produced by a joint committee from ASRA and the European Society of Regional Anesthesia and Pain Therapy. This joint committee was established to recommend to members and institutions the scope of practice, the teaching curriculum, and the options for implementing the medical practice of UGRA.
This document specifically defines the following:
1. 10 common tasks used when performing an ultrasound-guided nerve block,
2. the core competencies and skill sets associated with UGRA,
3. a training practice pathway for postgraduate anesthesiologists, and
4. a residency-based training pathway.
In both the residency and postgraduate pathways, training, competency, and proficiency requirements include both didactic and experiential components. The Joint Committee recommends that the decision to grant UGRA privileges be based at the individual institution level. Each institution that conducts UGRA is encouraged to support a productive quality improvement process.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>1/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200901000-00011</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/07000/Ultrasound_Machine_Comparison__An_Evaluation_of.13.aspx</link>
      <author>Wynd, Kimberly P.; Smith, Hugh M.; Jacob, Adam K.; Torsher, Laurence C.; Kopp, Sandra L.; Hebl, James R.</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Ultrasound Machine Comparison: An Evaluation of Ergonomic Design, Data Management, Ease of Use, and Image Quality]]></title>
      <description><![CDATA[Background and Objectives: The use of ultrasound technology for vascular access and regional anesthesia is gaining widespread acceptance among anesthesia providers. As a result, many group practices and medical institutions are considering purchasing ultrasound equipment. Currently, comparative information regarding the ergonomic design, physical and adjustable features, data management, ease of use, cost, and image quality of various ultrasound machines is not available. The primary goal of this investigation was to develop an objective process of evaluating ultrasound equipment before purchase. The process of evaluation used in the current investigation may be used when comparing a variety of medical technologies.
Methods: A randomized, side-by-side comparative evaluation of 7 different ultrasound machine models was performed. Sixteen resident physicians without prior ultrasound experience (inexperienced providers) completed a formal evaluation of each machine model after performing a standardized machine configuration and performance checklist. Inexperienced providers and 10 faculty members experienced in ultrasound-guided regional anesthesia evaluated the image quality of 2 standardized images acquired from each machine model.
Results: Overall, evaluators rated questions on the machine evaluation form as "very good" or "outstanding" 70% or more of the time for all machine models. The largest, most complex ultrasound machine was rated as having the best image quality by both inexperienced and experienced providers. Ultrasound machine models with the simplest ergonomic design and user interface were rated highest by inexperienced study participants.
Conclusions: Anesthesia providers considering an ultrasound equipment purchase should objectively evaluate machine models that have features most important to their own clinical practice. Ergonomic design, physical and adjustable features, data management, ease of use, image quality, and cost are important features to consider when evaluating an ultrasound machine.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>7/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200907000-00013</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/05000/Outcome_Predictors_for_Sacroiliac_Joint__Lateral.6.aspx</link>
      <author>Cohen, Steven P.; Strassels, Scott A.; Kurihara, Connie; Crooks, Matthew T.; Erdek, Michael A.; Forsythe, Akara; Marcuson, Matthew</author>
      <category>Original Articles</category>
      <title><![CDATA[Outcome Predictors for Sacroiliac Joint (Lateral Branch) Radiofrequency Denervation]]></title>
      <description><![CDATA[Background and Objective: Sacroiliac (SI) joint pain is a challenging condition characterized by limited treatment options. Recently, numerous studies have reported excellent intermediate-term outcomes after lateral-branch radiofrequency (RF) denervation, but these studies are characterized by wide variability in technique, selection criteria, and patient characteristics. The purpose of this study was to determine whether any demographic or clinical variables can be used to predict SI joint RF denervation outcome.
Methods: Seventy-seven patients with refractory, injection-confirmed SI joint pain underwent SI joint denervation at 2 academic institutions. A composite binary variable "successful" outcome was predefined as greater than 50% reduction in pain lasting at least 6 months coupled with a positive global perceived effect. Secondary outcome measures included Oswestry Disability Index scores, medication reduction, and retention on active duty for soldiers. Factors retrospectively evaluated for their association with outcome included demographic variables, duration of pain, opioid usage, pain referral pattern, physical examination signs, number of blocks and percentage of pain relief after SI joint injection, prognostic lateral-branch blocks, previous surgery, levels lesioned, RF technique, disability status, and coexisting medical conditions.
Results: Forty patients (52%) obtained a positive outcome. In multivariate analysis, preprocedure pain intensity, age older than 65 years, and pain radiating below the knee were significant predictors of failure. A trend was noted whereby patients receiving regular opioid therapy were more likely to experience a negative outcome. The use of cooled, rather than conventional RF, was associated with a higher percentage of positive outcomes.
Conclusions: Whereas several factors were found to influence outcome, no single clinical variable reliably predicted treatment results. The use of more stringent selection criteria was not associated with better outcomes.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>5/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200905000-00006</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/Ultrasound_Guided_Interventional_Procedures_in.15.aspx</link>
      <author>Peng, Philip W.H.; Narouze, Samer</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Ultrasound-Guided Interventional Procedures in Pain Medicine: A Review of Anatomy, Sonoanatomy, and Procedures: Part I: Nonaxial Structures]]></title>
      <description><![CDATA[Application of ultrasound in pain medicine is a rapidly growing medical field in interventional pain management. Ultrasound provides direct visualization of various soft tissues and real-time needle advancement and avoids exposing both the health care provider and the patient to the risks of radiation. The machine itself is more affordable than a fluoroscope, computed tomography scan, or magnetic resonance imaging machine. In the present review, we discuss the challenges and limitations of ultrasound-guided procedures for pain management, anatomy, and sonoanatomy of selected pain management procedures and the literature on those selected procedures.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00015</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/11000/Ultrasound_in_Regional_Anesthesia__Where_Should.1.aspx</link>
      <author>Sites, Brian D.; Neal, Joseph M.; Chan, Vincent</author>
      <category>Editorial</category>
      <title><![CDATA[Ultrasound in Regional Anesthesia: Where Should the "Focus" Be Set?]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200911000-00001</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/03000/Upper_Extremity_Regional_Anesthesia__Essentials_of.11.aspx</link>
      <author>Neal, Joseph M.; Gerancher, J.C.; Hebl, James R.; Ilfeld, Brian M.; McCartney, Colin J.L.; Franco, Carlo D.; Hogan, Quinn H.</author>
      <category>Review Articles</category>
      <title><![CDATA[Upper Extremity Regional Anesthesia: Essentials of Our Current Understanding, 2008]]></title>
      <description><![CDATA[Brachial plexus blockade is the cornerstone of the peripheral nerve regional anesthesia practice of most anesthesiologists. As part of the American Society of Regional Anesthesia and Pain Medicine's commitment to providing intensive evidence-based education related to regional anesthesia and analgesia, this article is a complete update of our 2002 comprehensive review of upper extremity anesthesia. The text of the review focuses on (1) pertinent anatomy, (2) approaches to the brachial plexus and techniques that optimize block quality, (4) local anesthetic and adjuvant pharmacology, (5) complications, (6) perioperative issues, and (6) challenges for future research.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>3/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200903000-00011</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/Abstracts_of_the_XXVIII_Annual_European_Society_of.40.aspx</link>
      <category>Online-Only</category>
      <title><![CDATA[Abstracts of the XXVIII Annual European Society of Regional Anaesthesia Congress, Salzburg, Austria, September 9-12, 2009]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00040</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/11000/Preliminary_Results_of_the_Australasian_Regional.2.aspx</link>
      <author>Barrington, Michael J.; Watts, Steve A.; Gledhill, Samuel R.; Thomas, Rowan D.; Said, Simone A.; Snyder, Gabriel L.; Tay, Valerie S.; Jamrozik, Konrad</author>
      <category>Original Articles</category>
      <title><![CDATA[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]]></title>
      <description><![CDATA[Background and Objectives: Peripheral nerve blockade is associated with excellent patient outcomes after surgery; however, neurologic and other complications can be devastating for the patient. This article reports the development and preliminary results of a multicenter audit describing the quality and safety of peripheral nerve blockade.
Methods: From January 2006 to May 2008, patients who received peripheral nerve blockade had data relating to efficacy and complications entered into databases. All patients who received nerve blocks performed by all anesthetists during each hospital's contributing period were included. Patients were followed up by phone to detect potential neurologic complications. The timing of follow-up was either at 7 to 10 days or 6 weeks postoperatively, depending on practice location and time period. Late neurologic deficits were defined as a new onset of sensory and/or motor deficit consistent with a nerve/plexus distribution without other identifiable cause, and one of the following: electrophysiologic evidence of nerve damage, new neurologic signs, new onset of neuropathic pain in a nerve distribution area, paresthesia in relevant nerve/plexus distribution area.
Results: A total of 6950 patients received 8189 peripheral nerve or plexus blocks. Of the 6950 patients, 6069 patients were successfully followed up. In these 6069 patients, there were a total of 7156 blocks forming the denominator for late neurologic complications. Thirty patients (0.5%) had clinical features requiring referral for neurologic assessment. Three of the 30 patients had a block-related nerve injury, giving an incidence of 0.4 per 1000 blocks (95% confidence interval, 0.08-1.1:1000). The incidence of systemic local anesthetic toxicity was 0.98 per 1000 blocks (95% confidence interval, 0.42-1.9:1000).
Conclusions: These results indicate that the incidence of serious complications after peripheral nerve blockade is uncommon and that the origin of neurologic symptoms/signs in the postoperative period is most likely to be unrelated to nerve blockade.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200911000-00002</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/Electrical_Stimulation_Versus_Ultrasound_Guidance.17.aspx</link>
      <author>Mariano, Edward R.; Cheng, Gloria S.; Choy, Lynna P.; Loland, Vanessa J.; Bellars, Richard H.; Sandhu, NavParkash S.; Bishop, Michael L.; Lee, Daniel K.; Maldonado, Rosalita C.; Ilfeld, Brian M.</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Electrical Stimulation Versus Ultrasound Guidance for Popliteal-Sciatic Perineural Catheter Insertion: A Randomized Controlled Trial]]></title>
      <description><![CDATA[Background: Sciatic perineural catheters via a popliteal fossa approach and subsequent local anesthetic infusion provide potent analgesia and other benefits after foot and ankle surgery. Electrical stimulation (ES) and, more recently, ultrasound (US)-guided placement techniques have been described. However, because these techniques have not been compared in a randomized fashion, the optimal method remains undetermined. Therefore, we tested the hypotheses that popliteal-sciatic perineural catheters placed via US guidance require less time for placement and produce equivalent results, as compared with catheters placed using ES.
Methods: Preoperatively, subjects receiving a popliteal-sciatic perineural catheter for foot and/or ankle surgery were randomly assigned to either the ES with a stimulating catheter or US-guided technique with a nonstimulating catheter. The primary end point was catheter insertion duration (in minutes) starting when the US transducer (US group) or catheter-placement needle (ES group) first touched the patient and ending when the catheter-placement needle was removed after catheter insertion.
Results: All US-guided catheters were placed per protocol (n = 20), whereas only 80% of stimulation-guided catheters could be placed per protocol (n = 20, P = 0.106). All catheters placed per protocol in both groups resulted in a successful surgical block. Perineural catheters placed by US took a median (10th-90th percentile) of 5.0 min (3.9-11.1 min) compared with 10.0 min (2.0-15.0 min) for stimulation (P = 0.034). Subjects in the US group experienced less pain during catheter placement, scoring discomfort a median of 0 (0.0-2.1) compared with 2.0 (0.0-5.0) for the stimulation group (P = 0.005) on a numeric rating scale of 0 to 10.
Conclusions: Placement of popliteal-sciatic perineural catheters takes less time and produces less procedure-related discomfort when using US guidance compared with ES.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00017</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/11000/The_Transversus_Abdominis_Plane_Block,_When_Used.12.aspx</link>
      <author>Costello, Joseph F.; Moore, Albert R.; Wieczorek, Paul M.; Macarthur, Alison J.; Balki, Mrinalini; Carvalho, Jose C.A.</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[The Transversus Abdominis Plane Block, When Used as Part of a Multimodal Regimen Inclusive of Intrathecal Morphine, Does Not Improve Analgesia After Cesarean Delivery]]></title>
      <description><![CDATA[Background and Objectives: The transversus abdominis plane (TAP) block has been shown to provide analgesia for lower abdominal wall incisions. We evaluated the efficacy of the TAP block for post-cesarean delivery (CD) patients used as a part of a multimodal regimen.
Methods: Women undergoing elective CD under spinal anesthesia were randomized to receive the TAP block with ropivacaine (n = 50) or placebo (n = 50), in addition to a standard postoperative analgesic regimen inclusive of intrathecal opioids. At the end of the surgical procedure, all the patients received bilateral TAP blocks under real-time ultrasound guidance, with either 20 mL of ropivacaine 0.375% or saline, on each side. Each patient was assessed at 6, 12, 24, and 48 hrs postoperatively, and again 6 weeks after the surgical procedure. The primary outcome was the difference in visual analog scale pain scores with movement at 24 hrs postpartum. Other outcomes assessed were analgesic consumption, maternal satisfaction, and incidence of adverse effects.
Results: One hundred women were recruited, and 96 completed the study. The mean (SD) visual analog scale pain scores on movement at 24 hrs were not different between the ropivacaine and placebo groups (3.4 [2.4] and 3.2 [2.2] cm, respectively, P = 0.47). The pain scores at other times, and the supplemental opioid consumption, were also similar between the 2 groups. The overall incidence of pain at 6 weeks postpartum was 8.3%.
Conclusions: The TAP block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve the quality of post-CD analgesia.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200911000-00012</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/Meningeal__Postdural__Puncture_Headache,.11.aspx</link>
      <author>Harrington, Brian E.; Schmitt, Andrew M.</author>
      <category>Original Articles</category>
      <title><![CDATA[Meningeal (Postdural) Puncture Headache, Unintentional Dural Puncture, and the Epidural Blood Patch: A National Survey of United States Practice]]></title>
      <description><![CDATA[Background: Meningeal (postdural) puncture headache (MPH) is a familiar iatrogenic complication. The optimal means of prevention, management, and treatment of this disorder are uncertain. The purpose of this study was to determine current practice among United States (USA) anesthesiologists regarding MPH as well as the related issues of unintentional dural puncture (UDP), the epidural blood patch (EBP), and proposed alternatives to the EBP.
Methods: A survey form was sent as a single mailing to each practicing USA member of the American Society of Regional Anesthesia and Pain Medicine in June 2006.
Results: Data were analyzed from 1024 returned survey forms (29.4% response rate). Major findings were as follows: Written institutional protocols for managing UDP and MPH are uncommon. The preferred method of immediately dealing with an UDP when providing analgesia for labor is to reattempt the epidural at another level (73.4%). When intrathecal catheters are used for labor analgesia, they are most often removed immediately after delivery (56.5%). After UDP in the obstetric setting, aggressive hydration and encouraging bed rest are the most frequently used prophylactic measures against the development of MPH. Frequently used treatment options for MPH include aggressive hydration, the EBP, oral caffeine, oral nonopioid analgesics, and bed rest. With the exception of a uniform blood volume (16-20 mL), procedural details of the EBP vary considerably among practitioners. The use of materials other than blood for epidural patch is uncommon.
Conclusions: Various measures, many poorly supported by the literature, are used prophylactically after UDP and in the treatment of MPH. Despite being nearly universally used as treatment of MPH, the EBP procedure itself remains largely nonstandardized.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00011</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/Ultrasound_in_Pain_Medicine__Advanced_Weaponry_or.1.aspx</link>
      <author>Huntoon, Marc A.</author>
      <category>Editorials</category>
      <title><![CDATA[Ultrasound in Pain Medicine: Advanced Weaponry or Just a Fad?]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00001</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/Anatomic_Basis_to_the_Ultrasound_Guided_Approach.18.aspx</link>
      <author>Horn, Jean-Louis; Pitsch, Trevor; Salinas, Francis; Benninger, Brion</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Anatomic Basis to the Ultrasound-Guided Approach for Saphenous Nerve Blockade]]></title>
      <description><![CDATA[Background and Objectives: Successful blockade of the saphenous nerve using surface landmarks can be challenging. We evaluated the anatomic basis of performing a saphenous nerve block with ultrasound (US) using its relationship to the saphenous branch of descending genicular artery, sartorius muscle, and the adductor hiatus as defined by cadaveric measurements.
Methods: Using a total of 9 cadaveric knee dissections, the saphenous nerve and its relationship to the saphenous branch of the descending genicular artery (SBDGA) were examined. The distances from the patella to the distal end of the adductor canal and the bifurcation of the saphenous nerve were recorded. US images of an above-the-knee, subsartorial saphenous nerve block were reviewed.
Results: The saphenous nerve coursed with the SBDGA. It exited the adductor canal at a median of 10.25 cm (range, 7.0-11.5 cm) cephalad to the proximal patellar border and traveled closely with the SBDGA. At its bifurcation into the infrapatellar branch and sartorial branch, the saphenous nerve was at its closest approximation to the SBDGA. This point was found to be at a median of 2.7 cm (range, 2.1-3.4 cm) cephalad and a median of 6.6 cm (range, 5.0-9.0 cm) posterior to the proximal and posterior patellar border, respectively.
Conclusions: The US-guided approach for saphenous nerve blockade using its close anatomic relationship to the SBDGA is a feasible alternative to previously described surface landmark-based or US-guided paravenous approaches.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00018</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/Diabetes_Mellitus,_Independent_of_Body_Mass_Index,.6.aspx</link>
      <author>Gebhard, Ralf E.; Nielsen, Karen C.; Pietrobon, Ricardo; Missair, Andres; Williams, Brian A.</author>
      <category>Original Articles</category>
      <title><![CDATA[Diabetes Mellitus, Independent of Body Mass Index, Is Associated With a "Higher Success" Rate for Supraclavicular Brachial Plexus Blocks]]></title>
      <description><![CDATA[Background and Objectives: The prevalence of obesity and diabetes mellitus continues to rise in industrialized countries. The impact of diabetes on the practice of peripheral nerve block anesthesia, however, has not been fully elucidated. The authors retrospectively evaluated the influence of diabetes, body mass index (BMI), age, and sex on the success of supraclavicular block (SCB) placed with a landmark-based paresthesia technique.
Methods: The anesthetic records of 1858 consecutive patients who received an SCB were analyzed. Block success was documented solely on the day of surgery, without additional follow-up. Patients were categorized as diabetic (group D, n = 262) or nondiabetic (group ND, n = 1596). Block "success rate" (ie, general anesthesia not required to produce surgical conditions) was analyzed using multiple regression (multivariable linear and logistic) to assess the associations of diabetes and/or body mass index on successful surgical anesthesia.
Results: Patients in group D were more likely (odds ratio, 3.3) to have a "successful" SCB for surgical anesthesia than were patients in group ND (P < 0.0001). Body mass index, age, and sex were not associated predictors of SCB "success."
Conclusions: We speculate that the "higher success" of SCB in patients with diabetes may be explained by: (i) higher sensitivity of diabetic nerve fibers to local anesthetics, (ii) possible unknown intraneural penetration before injection, and/or (iii) preexisting neuropathy with accompanying decreased sensation. In the absence of additional follow-up on these patients, these data should generate outcomes research addressing dose-response curves for patients with diabetes or at risk for diabetes.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00006</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/07000/Ultrasound_Guided_Cervical_Selective_Nerve_Root.12.aspx</link>
      <author>Narouze, Samer N.; Vydyanathan, Amaresh; Kapural, Leonardo; Sessler, Daniel I.; Mekhail, Nagy</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Ultrasound-Guided Cervical Selective Nerve Root Block: A Fluoroscopy-Controlled Feasibility Study]]></title>
      <description><![CDATA[Background and Objectives: Reports of intravascular injection during cervical transforaminal injections, even after confirmation by contrast fluoroscopy, have led some to question the procedure's safety. As ultrasound allows for visualization of soft tissues, nerves, and vessels, thus potentially improving precision and safety, we evaluated its feasibility in cervical nerve root injections.
Methods: This is a prospective series of 10 patients who received cervical nerve root injections using ultrasound as the primary imaging tool, with fluoroscopic confirmation. Our radiologic target point was the posterior aspect of the intervertebral foramen just anterior to the superior articular process in the oblique view and at the midsagittal plane of the articular pillars in the anteroposterior (AP) view.
Results: The needle was exactly at the target point in 5 patients in the oblique view and in 3 patients in the AP views. The needle was within 3 mm in all patients in the lateral oblique view and in 8 patients in the AP view. In the remaining 2 patients, the needle was within 5 mm from the radiologic target. In 4 patients, we were able to identify vessels at the anterior aspect of the foramen, whereas 2 patients had critical vessels at the posterior aspect of the foramen, and in 1 patient, this artery continued medially into the foramen, most likely forming or joining a segmental feeder artery. In both cases, the vessels might well have been in the pathway of a needle correctly positioned under fluoroscopic control.
Conclusions: Our case series shows the feasibility of using ultrasound imaging to guide selective cervical nerve root injections. It may facilitate identifying critical vessels at unexpected locations relative to the intervertebral foramen and avoiding injury to such vessels, which is the leading cause of the reported complications from cervical nerve root injections. A randomized controlled trial to compare the effectiveness and safety of ultrasound imaging against other imaging techniques seems warranted.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>7/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200907000-00012</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2000/01000/Neurologic_Complications_of_Spinal_and_Epidural.17.aspx</link>
      <author>Horlocker, Terese T.; Wedel, Denise J.</author>
      <category>Review Article</category>
      <title><![CDATA[Neurologic Complications of Spinal and Epidural Anesthesia]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>1/1/2000 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200001000-00017</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/05000/Ultrasound_Guided_Obturator_Nerve_Block__An.17.aspx</link>
      <author>Sinha, Sanjay K.; Abrams, Jonathan H.; Houle, Timothy T.; Weller, Robert S.</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Ultrasound-Guided Obturator Nerve Block: An Interfascial Injection Approach Without Nerve Stimulation]]></title>
      <description><![CDATA[Background and Objectives: For knee surgery, obturator nerve block (ONB) has been shown to enhance postoperative analgesia provided by femoral block. Current techniques for obturator block use surface landmarks or ultrasound guidance (USG) with nerve stimulation. This preliminary observational study evaluated the success of an ultrasound-guided ONB without the additional use of nerve stimulation.
Methods: Thirty patients scheduled for knee surgery under general anesthesia with nerve block for postoperative analgesia had ONB performed using USG and injection of 10 mL 0.5% ropivacaine with epinephrine. Half of the ropivacaine was injected between the pectineus and adductor brevis muscles, and half between the adductor brevis and adductor magnus muscles. The strength of thigh adduction was measured at 5, 10, and 15 mins after injection, and 50% strength reduction at 15 mins indicated a successful block.
Results: All patients showed reduction of strength, and 28 of 30 or 93% met the criteria for successful block with mean strength reduction of 82.2% (SD, 21.6%) at 15 mins. Blocks were completed in 122 secs (SD, 33 secs).
Conclusions: Obturator nerve block using USG to achieve interfascial injection without nerve stimulation had success similar to that reported in studies using nerve stimulation.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>5/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200905000-00017</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/05000/Sacroiliac_Joint_Radiofrequency_Denervation__Who.1.aspx</link>
      <author>Kapural, Leonardo</author>
      <category>Editorials</category>
      <title><![CDATA[Sacroiliac Joint Radiofrequency Denervation: Who Benefits?]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>5/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200905000-00001</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/Correlation_Between_Ultrasound_Imaging,.19.aspx</link>
      <author>van Geffen, Geert J.; Moayeri, Nizar; Bruhn, Jörgen; Scheffer, Gert J.; Chan, Vincent W.; Groen, Gerbrand J.</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Correlation Between Ultrasound Imaging, Cross-Sectional Anatomy, and Histology of the Brachial Plexus: A Review]]></title>
      <description><![CDATA[The anatomy of the brachial plexus is complex. To facilitate the understanding of the ultrasound appearance of the brachial plexus, we present a review of important anatomic considerations. A detailed correlation of reconstructed, cross-sectional gross anatomy and histology with ultrasound sonoanatomy is provided.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00019</guid>
    </item>
    <item>
      <link>http://pdfs.journals.lww.com/rapm/1996/21020/Complications_Associated_With_Epidural_Steroid.12.pdf</link>
      <author>Abram, Stephen E.; O'Connor, Therese C.</author>
      <category>Literature Review:  PDF Only</category>
      <title><![CDATA[Complications Associated With Epidural Steroid Injections]]></title>
      <description><![CDATA[Background and Objectives. Warnings about the hazards of epidural steroid injections occasionally appear in both medical and lay literature despite a lack of objective data to support such concerns. This literature review was undertaken to survey reports of adverse reactions associated with that procedure.
Methods. The following types of publications from peer-reviewed medical literature was surveyed: reports on series of epidural and subarachnoid steroid injections for sciatica; reports of adverse effects of epidural and subarachnoid steroid injections for sciatica; review articles on epidural and subarachnoid steroid injections; and studies of the behavioral and histologic effects of epidural steroids and their vehicle in animals.
Results. Several cases of aseptic meningitis, arachnoiditis, and bacterial meningitis and one case of conus medullaris syndrome have been reported after subarachnoid steroid injections. Most of these complications occurred after multiple subarachnoid injections. Two cases of epidural abscess, one case of bacterial meningitis, and one case of aseptic meningitis have been reported following epidural steroid injections. Subarachnoid drug placement could not be ruled out in the meningitis cases.
Conclusions. There are few published reports of serious complications following epidural steroid injections. There are a few published reports of complications following subarachnoid steroid injections, most of which were associated with multiple injections over a prolonged time period.
(C)1996 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <guid isPermaLink="false">00115550-199621020-00012</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/01000/The_American_Society_of_Regional_Anesthesia_and.4.aspx</link>
      <author>Ivani, Giorgio; Ferrante, F. Michael</author>
      <category>Editorials</category>
      <title><![CDATA[The American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy Joint Committee Recommendations for Education and Training in Ultrasound Guided Regional Anesthesia: Why Do We Need These Guidelines?]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>1/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200901000-00004</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/Ultrasound_Guided_Low_Dose_Interscalene_Brachial.20.aspx</link>
      <author>Renes, Steven H.; Rettig, Harald C.; Gielen, Mathieu J.; Wilder-Smith, Oliver H.; van Geffen, Geert J.</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Ultrasound-Guided Low-Dose Interscalene Brachial Plexus Block Reduces the Incidence of Hemidiaphragmatic Paresis]]></title>
      <description><![CDATA[Background and Objectives: Interscalene brachial plexus block is associated with 100% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether an ultrasound (US)-guided interscalene brachial plexus block performed at the level of root C7 versus a nerve stimulation interscalene brachial plexus block, both using 10 mL of ropivacaine 0.75%, resulted in a lower incidence of hemidiaphragmatic paresis.
Methods: In a prospective randomized controlled trial, 30 patients scheduled for elective shoulder surgery under combined general anesthesia and interscalene brachial plexus block were included. Interscalene brachial plexus block using the same dose was performed using either US or nerve stimulation guidance of ropivacaine for both groups. General anesthesia was standardized. Ventilatory function was assessed using spirometry, and movement of the hemidiaphragm was assessed by US.
Results: Two patients in the US group showed complete paresis of the hemidiaphragm, but in the nerve stimulation group, 12 patients showed complete and 2 patients had partial paresis of the hemidiaphragm (13% versus 93%, respectively; P < 0.0001). Ventilatory function (forced expiratory volume at 1 second, forced vital capacity, and peak expiratory flow) was significantly reduced in the nerve stimulation group compared with the US-guided group (P < 0.05). One block failure occurred in the nerve stimulation group compared with none in the US group. No adverse effects occurred in either group.
Conclusions: Ultrasound-guided interscalene brachial plexus block performed at the level of root C7 using 10 mL of ropivacaine 0.75% reduces the incidence of hemidiaphragmatic paresis.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00020</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2008/09000/ASRA_Practice_Advisory_on_Neurologic_Complications.3.aspx</link>
      <author>Neal, Joseph M.; Bernards, Christopher M.; Hadzic, Admir; Hebl, James R.; Hogan, Quinn H.; Horlocker, Terese T.; Lee, Lorri A.; Rathmell, James P.; Sorenson, Eric J.; Suresh, Santhanam; Wedel, Denise J.</author>
      <category>ASRA Practice Advisory on neurologic complication</category>
      <title><![CDATA[ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine]]></title>
      <description><![CDATA[Neurologic complications associated with regional anesthesia and pain medicine practice are extremely rare. The ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine addresses the etiology, differential diagnosis, prevention, and treatment of these complications. This Advisory does not focus on hemorrhagic and infectious complications, because they have been addressed by other recent ASRA Practice Advisories. The current Practice Advisory offers recommendations to aid in the understanding and potential limitation of neurologic complications that may arise during the practice of regional anesthesia and pain medicine.
(C)2008 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <guid isPermaLink="false">00115550-200809000-00003</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/Parietal_Analgesia_Decreases_Postoperative.4.aspx</link>
      <author>Beaussier, Marc; El'Ayoubi, Hanna; Rollin, Maxime; Parc, Yann; Atchabahian, Arthur; Chanques, Gerald; Capdevila, Xavier; Lienhart, André; Jaber, Samir</author>
      <category>Original Articles</category>
      <title><![CDATA[Parietal Analgesia Decreases Postoperative Diaphragm Dysfunction Induced by Abdominal Surgery: A Physiologic Study]]></title>
      <description><![CDATA[Background and Objectives: The postoperative analgesic strategy may influence the magnitude of the postoperative diaphragmatic dysfunction (PODD) induced by abdominal surgery. The purpose of this physiologic study was to evaluate the effect of continuous preperitoneal wound infusion (CPWI) of ropivacaine on PODD after open colorectal surgery.
Methods: Twenty patients with American Society of Anesthesiologists physical status I or II undergoing open colorectal surgery were prospectively included during 2 consecutive 2-month periods. During the first period, we evaluated 10 consecutive patients who received conventional parenteral analgesia (intravenously administered morphine via patient-controlled analgesia and acetaminophen) without parietal analgesia (control group). These patients were compared with 10 consecutive patients who received conventional parenteral analgesia along with parietal analgesia using CPWI of 0.2% ropivacaine at 10 mL/hr for 48 hrs (CPWI group). Diaphragmatic function was assessed preoperatively and at 24 and 48 hrs postoperatively using the sniff nasal inspiratory pressure test (Psniff). Supplemental intravenously administered morphine boluses were administered as needed before Psniff assessments in the control group to reduce differences in pain intensity.
Results: Demographic and surgical data did not differ between the 2 groups, nor did preoperative Psniff values (71 cm H2O [SD, 20 cm H2O] vs 65 cm H2O [SD,15 cm H2O] in the control and CPWI groups, respectively). Postoperative Psniff was significantly decreased in the 2 groups, but the reduction was significantly greater in the control group than in the CPWI group both at 24 hrs (-58% [SD, 18%] vs -24% [SD, 19%]; P = 0.001) and at 48 hrs (-44% [SD, 31%] vs -11% [SD, 32%]; P = 0.027).
Conclusions: Parietal analgesia delivered via a CPWI of ropivacaine reduces PODD induced by open colorectal surgery.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00004</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2006/07000/The_Importance_and_Implications_of_Aseptic.6.aspx</link>
      <author>Hebl, James R.</author>
      <category>Special article</category>
      <title><![CDATA[The Importance and Implications of Aseptic Techniques During Regional Anesthesia]]></title>
      <description><![CDATA[No abstract available]]></description>
      <guid isPermaLink="false">00115550-200607000-00006</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/03000/Continuous_Femoral_Nerve_Block_Provides_Superior.3.aspx</link>
      <author>Dauri, Mario; Fabbi, Eleonora; Mariani, Pierpaolo; Faria, Skerdilajd; Carpenedo, Roberta; Sidiropoulou, Tatiana; Coniglione, Filadelfo; Silvi, Maria B.; Sabato, Alessandro F.</author>
      <category>Original Articles</category>
      <title><![CDATA[Continuous Femoral Nerve Block Provides Superior Analgesia Compared With Continuous Intra-articular and Wound Infusion After Anterior Cruciate Ligament Reconstruction]]></title>
      <description><![CDATA[Background and Objectives: This prospective, randomized, clinical trial compared pain intensity and analgesic drug consumption after anterior cruciate ligament (ACL) reconstruction with patellar tendon under femoral-sciatic nerve block anesthesia in patients who received either a continuous femoral nerve block (CFNB) or continuous local anesthetic wound and intra-articular infusions.
Methods: Fifty patients were randomized to CFNB (n = 25) or an ON-Q device (I-Flow Corp, Lake Forest, Calif) (n = 25). All patients received sciatic nerve block (25 mL of ropivacaine 7.5 mg/mL and clonidine 30 [mu]g). The first group received a CFNB (2 mg/mL of ropivacaine at 7 mL/hr), and the second group received a single-shot femoral nerve block (both using 25 mL of ropivacaine 7.5 mg/mL and clonidine 30 [mu]g). At the end of the intervention, an ON-Q device was positioned on the ON-Q patients to continuously infuse the patellar tendon wound and intra-articular cavity with ropivacaine 2 mg/mL at 2 mL/hr for each catheter. Data regarding demographic, hemodynamic, pain scores, adverse effects, and need for supplemental analgesia were registered in a 36-hr follow-up period.
Results: The CFNB group reported lower visual analog scale values than the ON-Q group: at rest at 12 hrs (2.4 [SD, 2.2] vs 5.4 [SD, 3.1]; P < 0.001) and on movement at 12 (3.1 [SD, 2.5] vs 6.3 [SD, 2.9]; P < 0.001) and 24 hrs (2.7 [SD, 1.9] vs 4.6 [SD, 2.6]; P = 0.01) after surgery. The number of morphine and ketorolac boluses was lower in the CNFB group (morphine: 3.2 [SD, 2.2] vs 6.2 [SD, 2.5]; P < 0.001; ketorolac: 1.1 [SD, 1.0] vs 2.4 [SD, 0.9]; P < 0.001).
Conclusion: Continuous femoral nerve block provides better analgesia than the continuous patellar tendon wound and intra-articular infusions after anterior cruciate ligament reconstruction with patellar tendon.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>3/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200903000-00003</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/05000/Ultrasound_of_the_Lateral_Femoral_Cutaneous_Nerve_.18.aspx</link>
      <author>Bodner, Gerd; Bernathova, Maria; Galiano, Klaus; Putz, Diana; Martinoli, Carlo; Felfernig, Michael</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Ultrasound of the Lateral Femoral Cutaneous Nerve: Normal Findings in a Cadaver and in Volunteers]]></title>
      <description><![CDATA[Objective: To assess the feasibility of ultrasound (US) in visualizing the lateral femoral cutaneous nerve (LFCN) in a cadaver and 8 volunteers.
Methods: Ultrasound and US-guided dye injection was performed in 1 cadaver to show the feasibility of detecting the LFCN. We then performed US in 8 volunteers to assess position of the nerve in respect to the anterior iliac spine. We subsequently performed US-guided anesthetic block of the LFCN on both sides with 0.3 mL local anesthetic. Success rate, time to maximum peak blockade, and duration of blockade were noted.
Results: Ultrasound allowed visualization of the LFCN in the cadaveric specimen on both sides and in all but 1 volunteer. Ultrasound-guided block of the LFCN was successful in all but 1 volunteer. The mean distance of LFCN from the anterior iliac spine was 2.9 cm on the right side and 2.8 cm on the left side. The mean duration of the block was 4.4 hours.
Conclusion: Ultrasound enables visualization of the LFCN in a cadaver and in volunteers. Ultrasound-guided injection successfully blocked the LFCN.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>5/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200905000-00018</guid>
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    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/11000/Feasibility_and_Efficacy_of_Ultrasound_Guided.10.aspx</link>
      <author>Manickam, Baskar; Perlas, Anahi; Duggan, Edel; Brull, Richard; Chan, Vincent W.S.; Ramlogan, Reva</author>
      <category>Brief Technical Reports</category>
      <title><![CDATA[Feasibility and Efficacy of Ultrasound-Guided Block of the Saphenous Nerve in the Adductor Canal]]></title>
      <description><![CDATA[Background and Objectives: Saphenous nerve (SN) block can be technically challenging because it is a small and exclusively sensory nerve. Traditional techniques using surface landmarks and nerve stimulation are limited by inconsistent success rates. This descriptive prospective study assesses the feasibility of performing an ultrasound-guided SN block in the distal thigh.
Methods: After the research ethics board's approval and written informed consent, 20 patients undergoing ankle or foot surgery underwent ultrasonography of the medial aspect of the thigh to identify the SN in the adductor canal, as it lies adjacent to the femoral artery (FA), deep to the sartorius muscle. An insulated needle was advanced in plane under real-time guidance toward the nerve. After attempting to elicit paresthesia with nerve stimulation, 2% lidocaine with 1:200,000 epinephrine (5 mL) and 0.5% bupivacaine (5 mL) were injected around the SN.
Results: The SN was identified in all patients, most frequently in an anteromedial position relative to the FA, at a depth of 2.7 +/- 0.6 cm and 12.7 +/- 2.2 cm proximal to the knee joint. Complete anesthesia in the SN distribution developed in all patients by 25 mins after injection.
Conclusions: In this small descriptive study, ultrasound-guided SN block in the adductor canal was technically simple and reliable, providing consistent nerve identification and block success.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200911000-00010</guid>
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    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/05000/Minimal_Local_Anesthetic_Volume_for_Peripheral.13.aspx</link>
      <author>Eichenberger, Urs; Stöckli, Stefan; Marhofer, Peter; Huber, Gudrun; Willimann, Patrick; Kettner, Stephan C.; Pleiner, Johannes; Curatolo, Michele; Kapral, Stephan</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Minimal Local Anesthetic Volume for Peripheral Nerve Block: A New Ultrasound-Guided, Nerve Dimension-Based Method]]></title>
      <description><![CDATA[Background and Objectives: Nerve blocks using local anesthetics are widely used. High volumes are usually injected, which may predispose patients to associated adverse events. Introduction of ultrasound guidance facilitates the reduction of volume, but the minimal effective volume is unknown. In this study, we estimated the 50% effective dose (ED50) and 95% effective dose (ED95) volume of 1% mepivacaine relative to the cross-sectional area of the nerve for an adequate sensory block.
Methods: To reduce the number of healthy volunteers, we used a volume reduction protocol using the up-and-down procedure according to the Dixon average method. The ulnar nerve was scanned at the proximal forearm, and the cross-sectional area was measured by ultrasound. In the first volunteer, a volume of 0.4 mL/mm2 of nerve cross-sectional area was injected under ultrasound guidance in close proximity to and around the nerve using a multiple injection technique. The volume in the next volunteer was reduced by 0.04 mL/mm2 in case of complete blockade and augmented by the same amount in case of incomplete sensory blockade within 20 mins. After 3 up-and-down cycles, ED50 and ED95 were estimated. Volunteers and physicians performing the block were blinded to the volume used.
Results: A total 17 of volunteers were investigated. The ED50 volume was 0.08 mL/mm2 (SD, 0.01 mL/mm2), and the ED95 volume was 0.11 mL/mm2 (SD, 0.03 mL/mm2). The mean cross-sectional area of the nerves was 6.2 mm2 (1.0 mm2).
Conclusions: Based on the ultrasound measured cross-sectional area and using ultrasound guidance, a mean volume of 0.7 mL represents the ED95 dose of 1% mepivacaine to block the ulnar nerve at the proximal forearm.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>5/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200905000-00013</guid>
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    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/Local_Anesthetics_in_the_Surgical_Wound_Is_the.2.aspx</link>
      <author>Kehlet, Henrik; Kristensen, Billy B.</author>
      <category>Editorials</category>
      <title><![CDATA[Local Anesthetics in the Surgical Wound-Is the Pendulum Swinging Toward Increased Use?]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00002</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/07000/Ultrasound_Guided_Lumbar_Medial_Branch_Block_in.11.aspx</link>
      <author>Rauch, Stefan; Kasuya, Yusuke; Turan, Alparslan; Neamtu, Aurel; Vinayakan, Anil; Sessler, Daniel I.</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Ultrasound-Guided Lumbar Medial Branch Block in Obese Patients: A Fluoroscopically Confirmed Clinical Feasibility Study]]></title>
      <description><![CDATA[Background and Objectives: Obesity is a major risk factor for lower back pain. Fluoroscope-guided medial branch block is a common diagnostic tool in these patients. Although approach to the facet joint guided by ultrasound has been demonstrated successfully in lean patients, its success in obese patients is unknown. We therefore evaluated the success rate of real-time ultrasound approach in obese patients in a clinical feasibility study.
Methods: We performed a total of 84 medial branch blocks in 20 obese patients (body mass index, >30 kg/m2) using ultrasound. We studied the success rate, measured depth to the facet joint, and assessed radiation dose and pain relief.
Results: Our success rate was 62% (52/84 blocks) when using ultrasound to guide needle placement. The average distance from skin to target point at the transverse process was 76 mm (SD, 15 mm). Skin-target depth was significantly different between L4 and L5 on both sides (P = 0.01). The needle advancement could not be tracked to the target. The verbal rating scale scores before, immediately after, and 24 hrs after the procedure were 7.1 (SD, 2.4), 4.3 (SD, 3.1), and 3.8 (SD, 2.7), respectively. The average radiation dose was 0.226 mGy/m2 (SD, 0.196 mGy/m2).
Conclusion: Medial branch blocks in obese patients cannot be performed by ultrasound guidance exclusively.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>7/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200907000-00011</guid>
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    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/11000/Less_Urinary_Tract_Infection_by_Earlier_Removal_of.3.aspx</link>
      <author>Zaouter, Cedrick; Kaneva, Pepa; Carli, Franco</author>
      <category>Original Articles</category>
      <title><![CDATA[Less Urinary Tract Infection by Earlier Removal of Bladder Catheter in Surgical Patients Receiving Thoracic Epidural Analgesia]]></title>
      <description><![CDATA[Background and Objectives: It is common practice to catheterize the bladder in the presence of epidural analgesia and to leave the bladder catheter in situ to avoid postoperative urinary retention. However, bladder catheterization carries the risk for urinary tract infection (UTI). The objective of this randomized control trial was to assess whether the incidence of UTI will differ among patients receiving standard care and patients who have the bladder catheterization discontinued on the morning after surgery with the epidural still functioning.
Methods: Patients at low risk for postoperative urinary retention, scheduled for thoracic and abdominal surgery and receiving continuous thoracic epidural analgesia, were randomized on the morning after surgery to 2 groups: in the early removal group (n = 105), the bladder catheter was removed on the same morning after surgery, whereas in the standard group (SG) (n = 110), the bladder catheter was removed when epidural analgesia was discontinued (3-5 days). Urinary bladder volume was assessed by ultrasound. Primary and secondary outcomes were the incidence of UTI and rate of recatheterization.
Results: Two hundred fifteen patients were randomized. There were 17 UTI cases in total, with 15 (14%) in the SG and 2 (2%) in the early removal group (P = 0.004). The incidence of recatheterizations was not different between the 2 groups (P = 0.09) and did not correlate with the site of epidural insertion. When matched for the types of surgery, the duration of hospital stay was longer in the patients who contracted UTI (P = 0.004). There were more patients older than 65 years in the SG.
Conclusions: Leaving the bladder catheter as long as the epidural analgesia is maintained results in a higher incidence of UTI and prolonged hospital stay. Removal of the bladder catheter on the morning after surgery does not lead to higher rate of catheterizations.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200911000-00003</guid>
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    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/01000/Ultrasound_Guided_Regional_Anesthesia_and.12.aspx</link>
      <author>Liu, Spencer S.; Ngeow, Justin E.; YaDeau, Jacques T.</author>
      <category>Review Article</category>
      <title><![CDATA[Ultrasound-Guided Regional Anesthesia and Analgesia: A Qualitative Systematic Review]]></title>
      <description><![CDATA[Ultrasound guidance has become popular for performance of regional anesthesia and analgesia. This systematic review summarizes existing evidence for superior risk to benefit profiles for ultrasound versus other techniques. Medline was systematically searched for randomized controlled trials (RCTs) comparing ultrasound to another technique, and for large (n > 100) prospective case series describing experience with ultrasound-guided blocks. Fourteen RCTs and 2 case series were identified for peripheral nerve blocks. No RCTs or case series were identified for perineural catheters. Six RCTs and 1 case series were identified for epidural anesthesia. Overall, the RCTs and case series reported that use of ultrasound significantly reduced time or number of attempts to perform blocks and in some cases significantly improved the quality of sensory block. The included studies reported high incidence of efficacy of blocks with ultrasound (95%-100%) that was not significantly different than most other techniques. No serious complications were reported in included studies. Current evidence does not suggest that use of ultrasound improves success of regional anesthesia versus most other techniques. However, ultrasound was not inferior for efficacy, did not increase risk, and offers other potential patient-oriented benefits. All RCTs are rather small, thus completion of large RCTs and case series are encouraged to confirm findings.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>1/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200901000-00012</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/01000/Interscalene_Perineural_Catheter_Placement_Using.13.aspx</link>
      <author>Mariano, Edward R.; Loland, Vanessa J.; Ilfeld, Brian M.</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Interscalene Perineural Catheter Placement Using an Ultrasound-Guided Posterior Approach]]></title>
      <description><![CDATA[Background and Objectives: The posterior approach to the brachial plexus-or cervical paravertebral block-has advantages over the anterolateral interscalene approach, but concerns regarding "blind" needle placement near the neuraxis have limited the acceptance of this useful technique. We present a technique to place an interscalene perineural catheter that potentially decreases neuraxial involvement with the use of ultrasound guidance.
Methods: A 55-year-old man scheduled for total shoulder arthroplasty underwent placement of an interscalene perineural catheter. The posterior approach was selected to avoid the external jugular vein and anticipated sterile surgical field. Under in-plane ultrasound guidance, a 17-gauge insulated Tuohy-tip needle was inserted between the levator scapulae and trapezius muscles, and guided through the middle scalene muscle, remaining less than 2 cm below the skin throughout. Deltoid and biceps contractions were elicited at a current of 0.6 mA, and a 19-gauge stimulating catheter was advanced 5 cm beyond the needle tip, without a concomitant decrease in motor response.
Results: The initial 40 mL 0.5% ropivacaine bolus via the catheter resulted in unilateral anesthesia typical of an interscalene block; and subsequent perineural infusion of 0.2% ropivacaine was delivered via portable infusion pump through postoperative day 4.
Conclusions: Continuous interscalene block using an ultrasound-guided posterior approach is an alternative technique that retains the benefits of posterior catheter insertion, but potentially reduces the risk of complications that may result from blind needle insertion.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>1/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200901000-00013</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/11000/Hemidiaphragmatic_Paresis_Can_Be_Avoided_in.14.aspx</link>
      <author>Renes, Steven H.; Spoormans, Hubertus H.; Gielen, Mathieu J.; Rettig, Harald C.; van Geffen, Geert J.</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Hemidiaphragmatic Paresis Can Be Avoided in Ultrasound-Guided Supraclavicular Brachial Plexus Block]]></title>
      <description><![CDATA[Background and Objectives: Supraclavicular brachial plexus block is associated with 50% to 67% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether ultrasound-guided compared with nerve stimulation supraclavicular brachial plexus block using 0.75% ropivacaine results in a lower incidence of hemidiaphragmatic paresis.
Methods: In a prospective randomized observer-blinded controlled trial, 60 patients scheduled for elective elbow, forearm, wrist, or hand surgery under supraclavicular brachial plexus block without sedation were included. Supraclavicular brachial plexus block was performed with 20 mL of 0.75% ropivacaine using either ultrasound or nerve stimulation guidance. Ventilatory function was assessed by ultrasound examination of hemidiaphragmatic movement and spirometry.
Results: None of the 30 patients in the ultrasound group showed complete or partial paresis of the hemidiaphragm (95% confidence interval, 0.00-0.14), whereas in the nerve stimulation group, 15 patients showed complete paresis of the hemidiaphragm and 1 patient showed partial paresis of the hemidiaphragm (0% versus 53%, respectively; P < 0.0001). Ventilatory function (forced expiratory volume 1, forced vital capacity, peak expiratory flow) was significantly reduced in the nerve stimulation group compared with the ultrasound-guided group (P < 0.05). Two block failures occurred in the nerve stimulation group compared with none in the ultrasound group (P = 0.49). No adverse effects occurred in either group.
Conclusions: Ultrasound-guided supraclavicular brachial plexus block, using 20 mL of 0.75% ropivacaine with the described technique, is not associated with hemidiaphragmatic paresis.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200911000-00014</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2002/09000/Gabapentin_in_Postamputation_Phantom_Limb_Pain__A.7.aspx</link>
      <author>Bone, Margaret; Critchley, Peter; Buggy, Donal J.</author>
      <category>Original Articles</category>
      <title><![CDATA[Gabapentin in Postamputation Phantom Limb Pain: A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Study]]></title>
      <description><![CDATA[Background and Objectives: Severe phantom limb pain after surgical amputation affects 50% to 67% of patients and is difficult to treat. Gabapentin is effective in several syndromes of neuropathic pain. Therefore, we evaluated its analgesic efficacy in phantom limb pain.
Methods: Patients attending a multidisciplinary pain clinic with phantom limb pain were enrolled into this randomized, double-blind, placebo-controlled, cross-over study. Other anticonvulsant therapy was discontinued. Each treatment was 6 weeks separated by a 1-week washout period. Codeine/paracetamol was allowed as rescue analgesia. The daily dose of gabapentin was titrated in increments of 300 mg to 2,400 mg or the maximum tolerated dose. Patients were assessed at weekly intervals. The primary outcome measure was visual analog scale (VAS) pain intensity difference (PID) compared with baseline at the end of each treatment. Secondary measures were indices of sleep interference, depression (Hospital Anxiety and Depression [HAD] scale), and activities of daily living (Bartel Index).
Results: Nineteen eligible patients (mean age, 56 years; range, 24 to 68 years; 16 men) were randomized, of whom 14 completed both arms of the study. Both placebo and gabapentin treatments resulted in reduced VAS scores compared with baseline. PID was significantly greater than placebo for gabapentin therapy at the end of the treatment (3.2 +/- 2.1 v 1.6 +/- 0.7, P = .03). There were no significant differences between placebo and gabapentin therapy in terms of the number of tablets of rescue medication required, sleep interference, HAD scale, or Bartel Index. The medication was well tolerated with few reports of adverse effects.
Conclusions: After 6 weeks, gabapentin monotherapy was better than placebo in relieving postamputation phantom limb pain. There were no significant differences in mood, sleep interference, or activities of daily living, but a type II error cannot be excluded for these variables. Reg Anesth Pain Med 2002;27:481-486.
(C)2002 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <guid isPermaLink="false">00115550-200209000-00007</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2008/03000/American_Society_of_Regional_Anesthesia_and_Pain.16.aspx</link>
      <category>Book review</category>
      <title><![CDATA[American Society of Regional Anesthesia and Pain Medicine, Annual Pain Medicine Meeting and Workshops, November 15-18, 2007, Boca Raton, Florida: Numbers listed are abstract numbers]]></title>
      <description><![CDATA[No abstract available]]></description>
      <guid isPermaLink="false">00115550-200803000-00016</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/Future_Considerations_for_Pharmacologic_Adjuvants.14.aspx</link>
      <author>Williams, Brian A.; Murinson, Beth B.; Grable, Benjamin R.; Orebaugh, Steven L.</author>
      <category>Translational Vignette</category>
      <title><![CDATA[Future Considerations for Pharmacologic Adjuvants in Single-Injection Peripheral Nerve Blocks for Patients With Diabetes Mellitus]]></title>
      <description><![CDATA[As the epidemics of obesity and diabetes expand, there are more patients with these disorders requiring elective surgery. For surgery on the extremities, peripheral nerve blocks have become a highly favorable anesthetic option when compared with general anesthesia. Peripheral blocks reduce respiratory and cardiac stresses, while potentially mitigating untreated peripheral pain that can foster physiologic conditions that increase risks for general health complications. However, local anesthetics are generally accepted to be a rare but possible cause of nerve damage, and there are no evidence-based recommendations for dosing local anesthetic nerve blocks in patients with diabetes. This is important because anesthesiologists do not want to potentially accelerate peripheral nerve dysfunction in diabetic patients at risk. This translational vignette (i) examines laboratory models of diabetes, (ii) summarizes the pharmacology of perineural adjuvants (epinephrine, clonidine, buprenorphine, midazolam, tramadol, and dexamethasone), and (iii) identifies areas that warrant further research to determine viability of monotherapy or combination therapy for peripheral nerve analgesia in diabetic patients. Conceivably, future translational research regarding peripheral nerve blocks in diabetic patients may logically include study of nontoxic injectable analgesic adjuvants, in combination, to provide desired analgesia, while possibly avoiding peripheral nerve toxicity that diabetic animal models have exhibited when exposed to traditional local anesthetics.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00014</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/03000/Ultrasound_Guided_Supraclavicular_Block__Outcome.12.aspx</link>
      <author>Perlas, Anahi; Lobo, Giovanni; Lo, Nick; Brull, Richard; Chan, Vincent W.S.; Karkhanis, Reena</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Ultrasound-Guided Supraclavicular Block: Outcome of 510 Consecutive Cases]]></title>
      <description><![CDATA[Introduction: Supraclavicular brachial plexus block provides consistently effective anesthesia to the upper extremity. However, traditional nerve localization techniques may be associated with a high risk of pneumothorax. In the present study, we report block success and clinical outcome data from 510 consecutive patients who received an ultrasound-guided supraclavicular block for upper extremity surgery.
Methods: After institutional review board approval, the outcome of 510 consecutive patients who received an ultrasound-guided supraclavicular block for upper extremity surgery was reviewed. Real-time ultrasound guidance was used with a high-frequency linear probe. The neurovascular structures were imaged on short axis, and the needle was inserted using an in-plane technique with either a medial-to-lateral or lateral-to-medial orientation.
Results: Five hundred ten ultrasound-guided supraclavicular blocks were performed (50 inpatients, 460 outpatients) by 47 different operators at different levels of training over a 24-month period. Successful surgical anesthesia was achieved in 94.6% of patients after a single attempt; 2.8% required local anesthetic supplementation of a single peripheral nerve territory; and 2.6% received an unplanned general anesthetic. No cases of clinically symptomatic pneumothorax developed. Complications included symptomatic hemidiaphragmatic paresis (1%), Horner syndrome (1%), unintended vascular punctures (0.4%), and transient sensory deficits (0.4%).
Conclusions: Ultrasound-guided supraclavicular block is associated with a high rate of successful surgical anesthesia and a low rate of complications and thus may be a safe alternative for both inpatients and outpatients. Severe underlying respiratory disease and coagulopathy should remain a contraindication for this brachial plexus approach.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>3/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200903000-00012</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/05000/The_Rectus_Sheath_Block__Accuracy_of_Local.14.aspx</link>
      <author>Dolan, John; Lucie, Philip; Geary, Timothy; Smith, Malcolm; Kenny, Gavin N.C.</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[The Rectus Sheath Block: Accuracy of Local Anesthetic Placement by Trainee Anesthesiologists Using Loss of Resistance or Ultrasound Guidance]]></title>
      <description><![CDATA[Background and Objectives: The aim of this study was to compare the accuracy of local anesthetic placement in the rectus sheath block when performed by trainee anesthetists using loss of resistance (LOR) or ultrasound guidance.
Methods: Eighty-one patients undergoing laparoscopic surgery were randomly assigned to undergo rectus sheath block by either LOR or ultrasound guidance. Trainee anesthesiologists were also randomly assigned to provide the rectus sheath block by LOR or by using ultrasound. The placement of local anesthetic was recorded using ultrasound.
Results: The placement of local anesthetic by LOR was accurate in 45% of attempts but was superficial and deep to the rectus sheath in 34% and 21% of punctures, respectively. Accurate placement of local anesthetic within the rectus sheath decreased significantly as body mass index increased. Ultrasound guidance significantly improved the accuracy of needle placement, with 89% of abdominal punctures being correctly placed at the time of first injection of local anesthetic. An additional fascial plane lying at variable distance above the anterior layer of the rectus sheath was commonly observed.
Conclusions: Ultrasound guidance improves the accuracy of local anesthetic placement when undertaking the rectus sheath block. An additional fascial plane above the anterior layer of the rectus sheath may be wrongly perceived as the anterior layer of the rectus sheath when the block is undertaken without the aid of ultrasound.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>5/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200905000-00014</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/11000/Sonoanatomy_of_the_Lumbar_Spine_of_Pregnant_Women.11.aspx</link>
      <author>Borges, Bruno C.R.; Wieczoreck, Paul; Balki, Mrinalini; Carvalho, Jose C.A.</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[Sonoanatomy of the Lumbar Spine of Pregnant Women at Term]]></title>
      <description><![CDATA[Background and Objectives: Spinal ultrasound offers valuable information to facilitate the placement of lumbar neuraxial anesthesia. Lumbar spine sonograms are unique, and aspects may appear atypical at times, particularly the ligamentum flavum (LF). The objective of this study was to describe the sonoanatomy of the lumbar spine and to determine the frequency of atypical images of the LF in pregnant women at term.
Methods: Using a 2-5 MHz curvilinear transducer, we imaged all the lumbar interspaces in the left and right paramedian longitudinal and transverse planes. The images were categorized as typical, atypical or inconclusive. The primary outcome was the presence of an atypical image of the LF in the transverse plane. The distance from the skin to the epidural space, and the dural sac width, were also measured.
Results: One hundred subjects were studied. All the images in the longitudinal planes were conclusive and typical, whereas the number of inconclusive images in the transverse plane increased from L1-L2 to L5-S1 (1, 0, 4, 9, and 34, respectively). The incidence of atypical LF images in the transverse plane was 2.0% at L1-L2, 1.0% at L2-L3, 3.1% at L3-L4, 19.8% at L4-L5, and 28.8% at L5-S1.
Conclusions: The paramedian longitudinal sonograms of the lumbar spine are of superior quality to those obtained in the transverse plane. When using the transverse approach, a high incidence of inconclusive sonograms should be expected in the lower segments. The incidence of atypical LF images, especially in the upper lumbar segments, warrants further investigation because it can have implications for the epidural technique.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200911000-00011</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/11000/Pain__Friend_or_Foe__A_Neurobiologic_Perspective_.8.aspx</link>
      <author>Cervero, Fernando</author>
      <category>Special Article</category>
      <title><![CDATA[Pain: Friend or Foe? A Neurobiologic Perspective: The 2008 Bonica Award Lecture]]></title>
      <description><![CDATA[Pain is a protective sensation, but it can also be a burden without any useful value. Pain as a friend warns of impending damage and protects the body from injury. Pain as a foe is a useless sensation that makes the underlying problem worse and becomes a disease in its own right. Mechanistically, the systems that mediate good pain and bad pain are often the same, with bad pain being the result of such mechanisms being triggered inappropriately, by irrelevant stimuli or with a time course and intensity disproportionate to the originating cause. We are beginning to know more about the neurobiology of bad pain. The relevant mechanisms are often linked to dysfunction or disease of the nervous system, either of the peripheral nerves or of the central nervous system itself. For example, under normal conditions, activity in large, myelinated A[beta]-fibers inhibits nociceptive primary afferent inputs to the central nervous system. However, in inflammatory and neuropathic conditions, these actions are reversed, leading to touch-evoked pain or tactile allodynia. The mechanism responsible for this reversal is a change in the synaptic actions of [gamma]-aminobutyric acid that switches from being an inhibitory neurotransmitter to an excitatory one. Our challenge was to devise methods for pain relief based on elimination of the useless aspects of pain and the restoration of the protective qualities of normal pain sensation.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200911000-00008</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2005/01000/Lower_Extremity_Peripheral_Nerve_Blockade_.2.aspx</link>
      <author>Enneking, Kayser F.; Chan, Vincent; Greger, Jenny; Hadžic, Admir; Lang, Scott A.; Horlocker, Terese T.</author>
      <category>Original articles</category>
      <title><![CDATA[Lower-Extremity Peripheral Nerve Blockade: Essentials of Our Current Understanding]]></title>
      <description><![CDATA[No abstract available]]></description>
      <guid isPermaLink="false">00115550-200501000-00002</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/A_Comparison_of_Sensory_and_Motor_Loss_After_a.22.aspx</link>
      <author>Sites, Brian D.; Beach, Michael L.; Chinn, Christopher D.; Redborg, Kirsten E.; Gallagher, John D.</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[A Comparison of Sensory and Motor Loss After a Femoral Nerve Block Conducted With Ultrasound Versus Ultrasound and Nerve Stimulation]]></title>
      <description><![CDATA[Background: Controversy exists regarding the need for nerve stimulation when performing an ultrasound (US)-guided peripheral nerve block. We tested the hypothesis that the quality of a femoral nerve block (FNB) performed with US is equivalent to an FNB performed with US and nerve stimulation.
Methods: One hundred seven patients undergoing unilateral total knee arthroplasty were randomized to receive either a US-guided FNB (group US) or a US-guided FNB with nerve stimulation (group USNS). Thirty milliliters of bupivacaine 0.5% was injected in both groups. At 10, 20, 30, and 40 mins after block placement, blinded motor and sensory examinations were conducted. Secondary outcomes included time to perform the block, the number of needle redirections, and 24-hrs intravenously administered morphine equivalent consumption.
Results: There were no significant differences in the proportion of patients with either a partial or complete block. At 40 mins, 95.7% of the USNS subjects had a partial or complete sensory block of the femoral nerve (complete in 71.7% and partial in 24%) compared with 88.1% of US subjects (complete in 69% and partial in 19.1%; odds ratio, 2.97; P = 0.19). There were more needle redirections in group USNS (4.1 vs 1.1, P < 0.001), with a higher percentage of patients requiring 2 or more needle attempts (44.2% vs 18.9%, P < 0.01). The time to perform the block in group USNS was longer (188 vs 148 secs, P = 0.01).
Conclusion: The addition of nerve stimulation to a US-guided FNB did not change preoperative block efficacy.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00022</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/11000/A_Prospective_Randomized_Comparison_of_Ultrasound.13.aspx</link>
      <author>Fredrickson, Michael J.; Ball, Craig M.; Dalgleish, Adam J.</author>
      <category>Ultrasound Articles</category>
      <title><![CDATA[A Prospective Randomized Comparison of Ultrasound Guidance Versus Neurostimulation for Interscalene Catheter Placement]]></title>
      <description><![CDATA[Background and Objectives: Ultrasound (US) imaging facilitates catheter placement adjacent to the most appropriate elements of the brachial plexus, which for shoulder surgery are the C5-C6 roots or superior trunk. Therefore, it was investigated whether such placement would improve catheter effectiveness compared to placement with traditional techniques.
Methods: Needles introduced for catheter insertion were prospectively randomized to either US guidance immediately lateral to the C5-C6 roots/superior middle trunks (n = 43) or neurostimulation (NS) guidance to an appropriate motor response at less than 0.5 mA (n = 40). Ropivacaine 0.5% 30 mL was administered via the catheter before surgery under general anesthesia. After surgery, ropivacaine 0.2% infusion at 2 mL/hr with on-demand 5-mL boluses via an elastomeric pump was continued at home for 2 to 5 days. Patients were questioned regarding the need for ropivacaine boluses, tramadol, and numerical rating pain score (NRPS) on postoperative days 1 and 2.
Results: Catheter interventions for an NRPS of greater than 2 (0-10) in recovery were lower in the US group (US = 2/43, NS = 10/39; P = 0.007). Day 1 median ropivacaine bolus consumption (US = 1, NS = 2; P = 0.03) and the proportion of subjects requiring 2 or more tramadol tablets (US = 2/43, NS = 7/39; P = 0.04) were lower in the US group. These differences were not present on day 2. Postoperative pain was similar in both groups. Median (quartiles) needle time under the skin was lower in the US group (49 secs [41-55 secs]) than the NS group (97 secs [80-137 secs]) (P < 0.001) and was associated with a 1-point reduction in procedural NRPS (median [quartiles]: US = 2 [1-4], NS = 3 [2-6]; P = 0.002).
Conclusions: After shoulder surgery, interscalene catheters placed with US demonstrated improved effectiveness during the first 24 hrs compared with those placed with NS. These catheters were also placed with less needling and a very small reduction in procedure-related pain.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200911000-00013</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2008/09000/American_Society_of_Regional_Anesthesia_and_Pain.15.aspx</link>
      <category>ASRA annual spring meeting and workshops: Abstract listing</category>
      <title><![CDATA[American Society of Regional Anesthesia and Pain Medicine, Annual Spring Meeting and Workshops May 1-4, 2008, Playa del Carmen, Mexico: Numbers listed are abstract numbers]]></title>
      <description><![CDATA[No abstract available]]></description>
      <guid isPermaLink="false">00115550-200809000-00015</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/09000/Percutaneous_Upper_Thoracic_Radiofrequency.10.aspx</link>
      <author>Gabrhelik, Tomas; Michalek, Pavel; Adamus, Milan; Berta, Emil</author>
      <category>Original Articles</category>
      <title><![CDATA[Percutaneous Upper Thoracic Radiofrequency Sympathectomy in Raynaud Phenomenon: A Comparison of T2/T3 Procedure Versus T2 Lesion With Phenol Application]]></title>
      <description><![CDATA[Background and Objectives: Percutaneous radiofrequency (RF) thoracic sympathectomy is an alternative method to surgical procedures for the treatment of acral ischemia in Raynaud phenomenon. The procedure is indicated if conservative therapy fails to provide sufficient relief. The aim of this study was to compare classic T2 and T3 RF thermolesioning with a less invasive procedure at the level of T2 only.
Methods: Fifty adult patients, American Society of Anesthesiologists (ASA) classification I to III, were randomly assigned to 1 of 2 groups. T2 and T3 thoracic RF thermolesion was performed in 1 group, whereas T2 thermolesion with local application of 0.5 mL of 6% phenol was delivered in the second group. Changes in cold perception, pain, and quality of life were assessed using a questionnaire. Blood circulation in the upper extremity was evaluated using infrared thermography. Patients were observed for a period of 3 months.
Results: A significant decrease in pain according to visual analog scale (P < 0.001), increase in peripheral temperature in the upper extremities (P < 0.001), and improvement in quality of life were observed in both groups of patients after the procedure. Susceptibility to cold-provoked vasospasm was not significantly affected in either group. There was no significant difference between the 2 groups in any parameter apart from the duration of the procedure.
Conclusions: Thoracic RF upper sympathectomy is an effective method in the treatment of resistant forms of Raynaud phenomenon. A single-shot procedure at the level of T2 may be preferable because of the shorter procedure duration of this technique.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>9/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200909000-00010</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2008/09000/Anatomy_and_Pathophysiology_of_Spinal_Cord_Injury.5.aspx</link>
      <author>Neal, Joseph M.</author>
      <category>ASRA Practice Advisory on neurologic complication</category>
      <title><![CDATA[Anatomy and Pathophysiology of Spinal Cord Injury Associated With Regional Anesthesia and Pain Medicine]]></title>
      <description><![CDATA[No abstract available]]></description>
      <guid isPermaLink="false">00115550-200809000-00005</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/07000/Retained_Intrathecal_Catheter_Fragment_After.18.aspx</link>
      <author>Forsythe, Akara; Gupta, Anita; Cohen, Steven P.</author>
      <category>Case Reports</category>
      <title><![CDATA[Retained Intrathecal Catheter Fragment After Spinal Drain Insertion: Steps for Prevention and Management]]></title>
      <description><![CDATA[Background and Objectives: The placement of lumbar spinal drains is being done with increasing frequency to facilitate high-risk surgical procedures. One risk associated with these procedures is catheter shearing, resulting in a retained foreign body in the intrathecal space. Unlike retained epidural fragments, there are no guidelines on the management of this complication. The purpose of this article was to synthesize the literature on this subject to come up with guidelines for preventing and managing this complication.
Methods: Case report and review of all published cases.
Results: Most cases of retained catheters are associated with difficulty inserting or advancing the catheter. Among those cases treated conservatively, approximately one third of patients developed symptoms. Factors that must be considered when weighing the decision to surgically remove the retained catheter include patient comorbidities and desires, size and location of the fragment, infectious risk, the presence of neurologic symptoms, and scheduled surgical procedure.
Conclusions: A retained intrathecal catheter can be managed conservatively in certain contexts. Periodic follow-up visits, with or without repeat imaging, are recommended in these circumstances.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>7/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200907000-00018</guid>
    </item>
    <item>
      <link>http://journals.lww.com/rapm/Fulltext/2009/07000/Paravertebral_Block_in_Inguinal_Hernia_Surgeries_.6.aspx</link>
      <author>Özkan, Derya; Akkaya, Taylan; Cömert, Ayhan; Balkc, Nilgün; Özdemir, Esra; Gümüs, Haluk; Ergül, Zafer; Kaya, Oskay</author>
      <category>Original Articles</category>
      <title><![CDATA[Paravertebral Block in Inguinal Hernia Surgeries: Two Segments or 4 Segments?]]></title>
      <description><![CDATA[Background and Objectives: In this study, we compare paravertebral block (PVB) of the T10 and L1 segments and multiple-segment PVB for anesthesia and analgesia in inguinal hernia surgeries.
Methods: Anatomic study was performed on 3 cadavers. A 15-mL methylene blue solution was injected at the T10 level and then an additional 5-mL dye injection at L1 level. Fifty patients were included in the study. Patients in group 1 (n = 25) underwent PVB of 2 segments at the T10 and L1 vertebrae levels on the same side as the hernia, whereas patients in group 2 (n = 25) underwent PVB through 4 segments at T10, T11, T12, and L1 on the same side as the hernia. Perioperative propofol/remifentanil consumption, surgery start time, time to perform the block, duration of sensory block, postoperative visual analog scale scores, and complications were evaluated.
Results: Any passage down to the T12 level was not observed after injection at the T10 level and also only after additional 5-mL dye injection at the L1 level; the genitofemoral, ilioinguinal, iliohypogastric, and lateral femoral cutaneous nerves were stained with dye in cadavers. The times for block application were 5 mins (SD, 1 min) in group 1 and 16 mins (SD, 4 mins) in group 2 (P < 0.001). The surgery start time was 25 mins (SD, 3 mins) in group 1 and 27 mins (SD, 6 mins) in group 2 (P = 0.234). In both groups, propofol and remifentanil were used in similar quantities during the perioperative period. Use of paracetamol tablets was similar in both groups (P > 0.05). Whereas none of the patients in group 1 displayed motor block or contralateral spread, 2 patients in group 2 displayed contralateral spread, and motor block was observed in 1 patient. Twenty-three patients (92%) in group 1 and 24 patients (96%) in group 2 were satisfied with the method (P > 0.05).
Conclusion: Two-segment PVB can be an alternative to 4-segment PVB in inguinal hernia surgeries. Decreasing the number of injections required in this technique may further increase patient comfort and decrease complications.
(C)2009 American Society of Regional Anesthesia and Pain Medicine]]></description>
      <pubDate>7/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00115550-200907000-00006</guid>
    </item>
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