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Ultrasound-guided epidural

Ashok Jadon, Swapnil Nage, Chintala Pavana Swarupa, Mayur Motaka
We have reported a case of right upper limb injury of shoulder and elbow who was managed with ultrasound-guided interscalene block during surgery and indwelling catheter for postoperative analgesia. He developed weakness in the contralateral upper limb in the postoperative period due to inadvertent spread of local anaesthetic in the cervical epidural space. No serious complication occurred due to timely intervention. The possible pathways of such unwanted epidural spread and methods to reduce such complications have been discussed...
January 2019: Indian Journal of Anaesthesia
Mehmet Canturk, Fusun Karbancioglu Canturk, Nazan Kocaoglu, Meltem Hakki
BACKGROUND: Preprocedural ultrasound examination of vertebral column guides to locate desired intervertebral space and provides a prevision of needle trajectory and estimated needle depth in parturients. The objective of this study was to assess the correlation between ultrasound-estimated epidural depth (ED) with abdominal girth (AG), body mass index (BMI), weight, height, and age. METHODS: In this prospective, observational study, ultrasound imaging was done at L3-4 interspace in transverse median plane (TP) and paramedian sagittal oblique plane (PSO) to obtain ultrasound estimates of skin to epidural space depth...
February 8, 2019: Journal of Anesthesia
Nazmy Edward Seif, Ahmed Mohamed ELbadawy
Background: The aim of this randomized controlled study is to compare the safety and efficacy of thoracic spinal versus thoracic epidural anesthesia for open nephrectomy in patients with obstructive/restrictive lung disease. Methods: Sixty patients with mild to moderate chronic obstructive/restrictive lung disease undergoing open nephrectomy were randomized into two groups, 30 patients each. The thoracic spinal group (TSA) group received ultrasound guided mid-thoracic spinal anesthesia, and the thoracic epidural group (TEA) group received thoracic epidural anesthesia...
January 2019: Saudi Journal of Anaesthesia
Xin Zhang, Haifeng Shi, Jin Zhou, Yongming Xu, Shaofeng Pu, Yingying Lv, Junzhen Wu, Yueping Cheng, Dongping Du
Background: Cervical transforaminal epidural steroid injection (CTFESI) is used to provide pain relief and restore function in patients with cervical radiculopathy. Traditionally, it is performed under the guidance of fluoroscopy or computed tomography. Here, we introduce a novel technique - ultrasound-guided CTFESI - with which operators can easily distinguish the close soft tissue (nerve, vessels) around the cervical foramina to avoid intravascular injection during the procedure. Objective: To present the immediate and long-term effectiveness of ultrasound-guided CTFESI in patients with cervical radiculopathy in an academic pain-management center with prospective clinic experiments...
2019: Journal of Pain Research
Alessandra Novello-Siegenthaler, Mehdi Hamdani, Irène Iselin-Chaves, Roxane Fournier
BACKGROUND: Multiorifice catheters have been shown to provide superior analgesia and significantly reduce local anesthetic consumption compared with end-hole catheters in epidural studies. This prospective, blinded, randomized study tested the hypothesis that, in continuous femoral nerve block (CFNB) under ultrasound guidance, multiorifice catheter would reduce local anesthetic consumption at 24 h compared with end-hole catheter. METHODS: Eighty adult patients (aged ≥18 years) scheduled to undergo primary total knee arthroplasty under a combination of CFNB, sciatic nerve block and general anesthesia were randomized to CFNB using either a 3-pair micro-hole (Contiplex, BRAUN®, 20G - 400 mm) or an end-hole (Silverstim VYGON®, 20G - 500 mm) catheter...
December 19, 2018: BMC Anesthesiology
T Malik, O Malas, A Thompson
BACKGROUND: Based on their experience or training, anesthesiologists typically use the iliac crest as a landmark to choose the L3-4 or L2-3 interspace for labor epidural catheter placement. There is no evidence-based recommendation to guide the exact placement. We hypothesized that lower placement of the catheter would lead to a higher incidence of S2 dermatomal block and improved analgesia in late labor and at delivery. METHODS: One-hundred parturients requesting epidural analgesia were randomly assigned to receive ultrasound-guided L5-S1 epidural catheter placement (experimental group) or non-ultrasound-guided higher lumbar interspace placement (control group)...
November 20, 2018: International Journal of Obstetric Anesthesia
Dita Aditianingsih, Chaidir Arif Mochtar, Susilo Chandra, Raden Besthadi Sukmono, Ilham Wahyudi Soamole
Background: Postoperative pain management is important for the early recovery of the living donor patient. Patient-controlled opioid analgesia, epidural analgesia, or a combination of both is the preferred pain management after abdominal surgery although these approaches have serious side effects. The transversus abdominis plane (TAP) block has been increasingly used for postoperative pain management and the addition of dexamethasone to local anesthetic can prolong the duration of action...
October 2018: Anesthesiology and Pain Medicine
Ebru Canakci, Ahmet Gultekin, Zubeyir Cebeci, Bulent Hanedan, Anil Kilinc
Introduction and Objective: TAP block has gained popularity to provide postoperative analgesia after abdominal surgery but its advantage over epidural analgesia is disputed. For lower abdominal surgeries, epidural analgesia has been the gold standard and time-tested technique for providing postoperative analgesia, but contraindications for the same would warrant need for other equally good analgesic techniques. The objective of this study is to compare the analgesic efficacy of both the techniques...
2018: Pain Research & Management: the Journal of the Canadian Pain Society
Shabana Z Shafy, Mohammed Hakim, Mauricio Arce Villalobos, Gregory D Pearson, Giorgio Veneziano, Joseph D Tobias
Duchenne muscular dystrophy (DMD), first described in 1834, is an X-linked dystrophinopathy, leading to early onset skeletal muscle weakness. Life expectancy is reduced to early adulthood as a result of involvement of voluntary skeletal muscles with respiratory failure, orthopedic deformities, and associated cardiomyopathy. Given its multisystem involvement, surgical intervention may be required to address the sequelae of the disease process. We present a 36-year-old adult with DMD, who required anesthetic care during surgical debridement of an ischial pressure sore...
2018: Local and Regional Anesthesia
Chang-Soon Lee, Jae Young Lee, Soohan Ro, Seungeun Choi, Jee Youn Moon
BACKGROUND: High-intensity focused ultrasound (HIFU) is a noninvasive thermodestructive procedure targeting internal organs with concentrated sonification energy that may cause pain. We aimed to compare the effectiveness of epidural analgesia (EA) and monitored anesthesia care (MAC) in HIFU treatment of uterine adenomyosis. MATERIALS AND METHODS: Sixty-eight patients were included in this case-control study. Thirty-seven patients underwent MAC; 31 patients underwent fluoroscope-guided epidural analgesia...
October 10, 2018: International Journal of Hyperthermia
Hironobu Ueshima, Hiroshi Otake
RATIONALE: The relief of selective hip pain may be difficult to attain. Therefore, a deep nerve block such as epidural anesthesia or lumbar plexus nerve block is required. However, deep nerve blocks may not be possible in patients with complications, including severe cardiovascular disease. PATIENTS CONCERNS: The patient in our report had coronary stents inserted previously and required continuous anticoagulant therapy owing to severe heart failure. DIAGNOSIS: Bipolar hip arthroplasty was required in our patient because of a fracture of the neck of femur on the left side...
October 2018: Medicine (Baltimore)
Thomas M Hemmerling
BACKGROUND: Abdominal surgery has undergone major changes during the last two decades with a general shift from open, invasive surgery to closed minimally invasive surgery. Accordingly, pain management strategies have also changed, especially with the introduction of ultrasound-guided abdominal wall blocks. Despite laparoscopic abdominal surgery classified as minimal, pain can be quite significant and needs to be addressed appropriately. PURPOSE: This narrative review focuses on adequate pain strategies for various types of surgery...
November 2018: Langenbeck's Archives of Surgery
Tatiana H Ferreira, Leandro B C Teixeira, Carrie A Schroeder, Cristina de Miguel Garcia, Kristopher M Schroeder
OBJECTIVES: To describe an ultrasound-guided thoracic paravertebral block and determine the distribution after injection of two volumes of methylene blue in dog cadavers. STUDY DESIGN: Prospective experimental cadaveric study. ANIMALS: Twelve dog cadavers weighing 11 ± 3 kg. METHODS: Ultrasound-guided injections aimed at the fifth thoracic (T5) paravertebral space were performed in randomized order using 0.1 or 0.3 mL kg-1 dye solution (six dogs for each volume)...
November 2018: Veterinary Anaesthesia and Analgesia
Hyo Jeong Lee, Hong Souk Park, Hyun Im Moon, Seo Yeon Yoon
OBJECTIVES: To compare the efficacy of a conventional fluoroscopy-guided epidural nerve block and an ultrasound (US)-guided intercostal nerve block in patients with thoracic herpes zoster (HZ). METHODS: This work was a comparative study of 38 patients with thoracic HZ pain and a chest wall herpetic eruption, aged 18 years or older, with pain intensity of 5 or greater on a numeric rating scale (NRS) for less than a 1-month duration. Patients were consecutively enrolled and assigned to 2 groups in which the intervention was either the US-guided intercostal nerve block or the fluoroscopy-guided epidural nerve block approach with the addition of a 5-mL mix of 2...
September 23, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Purnima Narasimhan, Lokesh Kashyap, V K Mohan, Mahesh Kumar Arora, Dilip Shende, Maddur Srinivas, Seema Kashyap, Sayan Nath, Puneet Khanna
STUDY OBJECTIVE: This study was undertaken to compare the analgesic efficacy of ultrasound-guided single-shot caudal block with ultrasound-guided single-shot paravertebral block in children undergoing renal surgeries. DESIGN: Randomised, interventional, blinded clinical trial. SETTING: Operating rooms of All India Institute of Medical Sciences, New Delhi, India. PATIENTS: 50 children aged 2-10 years, of ASA status I/II, posted for elective renal surgeries...
September 19, 2018: Journal of Clinical Anesthesia
Yong Zhang, Fuhong Duan, Wuhua Ma
BACKGROUND: Continuous hiccups during surgery not only affect the surgical procedure, they can also cause adverse effects for the patient. Apart from active investigation of the cause of the hiccups, their timely termination is also necessary. CASE PRESENTATION: We reported a case of a 70-year-old woman with continuous intraoperative hiccups that appeared during vaginal hysterectomy under low continuous epidural anesthesia. After the ineffectiveness CO2 repeated inhalation and intravenous administration of chlorpromazine and methoxychlorpromide, we performed unilateral phrenic nerve block under ultrasound guidance...
September 5, 2018: BMC Anesthesiology
Hesham Elsharkawy, Robert Maniker, Robert Bolash, Prathima Kalasbail, Richard L Drake, Nabil Elkassabany
BACKGROUND AND OBJECTIVES: Fascial plane blocks are rapidly emerging to provide safe, feasible alternatives to epidural analgesia for thoracic and abdominal pain. We define a new option for chest wall and upper abdominal analgesia, termed the rhomboid intercostal and subserratus plane (RISS) block. The RISS tissue plane extends deep to the erector spinae muscle medially and deep to the serratus anterior muscle laterally. We describe a 2-part proof-of-concept study to validate the RISS block, including a cadaveric study to evaluate injectate spread and a retrospective case series to assess dermatomal coverage and analgesic efficacy...
October 2018: Regional Anesthesia and Pain Medicine
Tülay Şahin, Onur Balaban
Ultrasonography has gained popularity in recent years among anaesthesiologists and being used widely for regional blocks and central venous catheterization. Ultrasonography for neuraxial blocks was found beneficial especially for determining the correct needle insertion site and estimating the needle insertion depth of epidural space. In many recent studies, ultrasound guided epidural and spinal blocks have been evaluated among obstetric patients. Pre-procedural lumbar ultrasonography and real time ultrasound guidance for neuraxial blocks was the subject of these studies...
August 2018: Turkish Journal of Anaesthesiology and Reanimation
Hatem A El Shora, Ahmed A El Beleehy, Amr A Abdelwahab, Gaser A Ali, Tarek E Omran, Essam A Hassan, Amr A Arafat
BACKGROUND:  Adequate pain control after cardiac surgery is essential. Paravertebral block is a simple technique and avoids the potential complications of epidural catheters. The objective of this study is to compare the effect of ultrasound-guided bilateral thoracic paravertebral block with thoracic epidural block on pain control after cardiac surgery. MATERIALS AND METHODS:  Between March 2016 and 2017, 145 patients who had cardiac surgery through median sternotomy were randomized by stratified blocked randomization into two groups...
August 16, 2018: Thoracic and Cardiovascular Surgeon
Sayan Nath, Debesh Bhoi, Virender Kumar Mohan, Praveen Talawar
The postoperative pain management in open thoracotomy is very crucial as the effective analgesia can prevent respiratory and thrombotic complications and lead to early mobilization and discharge. The thoracic epidural analgesia is the gold standard in such surgeries; however, there are few adverse effects such as hypotension, dural puncture, and contralateral block that always warrants safer alternative. Recently, with the advent of ultrasound, the regional anesthetic techniques are getting more popular to avoid such complications...
July 2018: Saudi Journal of Anaesthesia
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