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Wagh HD. A novel and simple method to obtain a longitudinal ultrasound-guided view of a target. Anaesthesia 2021; 76:1672. [PMID: 34143445 DOI: 10.1111/anae.15523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- H D Wagh
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
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Wang Q, Zhang Y, Du J, Lin X. Proximal versus distal adductor canal blocks for total knee arthroplasty: A protocol for randomized controlled trial. Medicine (Baltimore) 2020; 99:e19995. [PMID: 32481369 DOI: 10.1097/md.0000000000019995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Currently, there remains a paucity of literature about the efficiency of proximal adductor canal block (PACB) versus distal adductor canal block (DACB) for pain management after total knee arthroplasty (TKA). The purpose of this study is to perform a randomized controlled trial to compare the efficiency of PACB versus DACB for early postoperative pain treatment after TKA. METHODS This study is a 2-arm, parallel-group, randomized controlled trial that is conducted at a single university hospital in China. Subjects presenting for unilateral TKA are randomized in a 1:1 ratio to either a PACB or DACB group. The primary outcome of this noninferiority study is opioid consumption within the first 24 hours following surgery. Secondary outcomes include quadriceps strength, pain scores, distance ambulated, and patient satisfaction. Continuous variables are compared using Student t test. RESULTS This clinical trial is expected to provide evidence of whether the PACB and DACB provide similar analgesia after TKA. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5440).
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Affiliation(s)
- Quan Wang
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang University, Hangzhou City, China
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Zhang B, Sun S, Sheng B. Multiple versus single doses of dexamethasone in total hip arthroplasty: A protocol of randomized controlled trial. Medicine (Baltimore) 2020; 99:e20147. [PMID: 32384500 PMCID: PMC7220463 DOI: 10.1097/md.0000000000020147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Reduction of post-operative pain, nausea, and vomiting in patients undergoing total hip arthroplasty (THA) may facilitate earlier discharge from hospital and reduce healthcare costs. The recommended dose regimen of dexamethasone in THA has not been determined. The purpose of this study was performed to compare the efficiency of multiple versus single doses of dexamethasone for early postoperative pain treatment after THA. METHODS This study was a randomized controlled trial which conducted in our hospital. Informed consent for participation in this trial was obtained from each patient before surgery. Two hundred patients undergoing THA received 1 dose of intravenous dexamethasone and 1 dose of normal saline (Group A), or 2 doses of intravenous dexamethasone (Group B). The primary outcome was visual analog scale pain scores in the immediate postoperative period. Secondary outcomes included postoperative opioid use, length of hospital stay, activity level during physical therapy, and hip range of motion. RESULTS This clinical trial might provide some insights to estimate the safety of dexamethasone. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5460).
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Affiliation(s)
| | - Shaoqiong Sun
- Department of Operation room, Panzhihua Central Hospital
| | - Bo Sheng
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Sichuan Province, China
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Battista C, Harmon E, Patel S, Ghoddoussi F, Lynch B, Nabavighadi K, Krishnan S. Ultrasound-guided out-of-plane (OOP) adductor canal continuous catheter placement compared to in-plane (IP) placement in total knee arthroplasty: Arandomized, single blinded, pilot clinical trial. J Clin Anesth 2019; 61:109692. [PMID: 31826830 DOI: 10.1016/j.jclinane.2019.109692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/17/2019] [Accepted: 12/01/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Carter Battista
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
| | - Elliot Harmon
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
| | - Samir Patel
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
| | - Farhad Ghoddoussi
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Brendan Lynch
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Kaveh Nabavighadi
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
| | - Sandeep Krishnan
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA.
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Hauritz RW, Hannig KE, Balocco AL, Peeters G, Hadzic A, Børglum J, Bendtsen TF. Peripheral nerve catheters: A critical review of the efficacy. Best Pract Res Clin Anaesthesiol 2019; 33:325-339. [PMID: 31785718 DOI: 10.1016/j.bpa.2019.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
Continuous peripheral nerve blocks are commonly used for postoperative analgesia after surgery. However, catheter failure may occur due to either primary (incorrect insertion) or secondary reasons (displacement, obstruction, disconnection). Catheter failure results in unanticipated pain, need for opioid use, and risk of readmission or delay in hospital discharge. This review aimed to assess definition and frequency of catheter failure, and discuss the alternatives to prolong duration of single-shot nerve blocks. A literature search was performed on peripheral catheters reporting failure as the main outcome measure. Thirty-three studies met the selection criteria, comprising 2711 catheters. Literature review suggests that peripheral nerve catheters have clinically significant failure rate when the assessment is performed using an objective (imaging) method. Subjective methods of assessment (without imaging) may underestimate the incidence of catheter failure.
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Affiliation(s)
- Rasmus W Hauritz
- Department of Anesthesia and Intensive Care Medicine, Kolding Hospital, Denmark
| | - Kjartan E Hannig
- Department of Anesthesia and Intensive Care Medicine, Kolding Hospital, Denmark
| | - Angela Lucia Balocco
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Gwendolyne Peeters
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Admir Hadzic
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Jens Børglum
- Department of Anesthesia and Intensive Care Medicine, Zealand University Hospital, Denmark
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Tran DQ, Salinas FV, Benzon HT, Neal JM. Lower extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med 2019; 44:rapm-2018-000019. [PMID: 30635506 DOI: 10.1136/rapm-2018-000019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 12/16/2022]
Abstract
The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine's ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.
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Affiliation(s)
- De Q Tran
- Department of Anesthesiology, McGill University, Montreal, Quebec, Canada
| | - Francis V Salinas
- Department of Anesthesiology, US Anesthesia Partners-Washington, Swedish Medical Center, Seattle, Washington, USA
| | - Honorio T Benzon
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joseph M Neal
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
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Abstract
Despite the widespread use of ambulatory continuous peripheral nerve blocks in adults, its use in children has been sporadic. Indications for the use of ambulatory continuous peripheral nerve block in children involve orthopedic procedure, where significant pain is anticipated beyond 24 hours. Techniques to place the perineural catheters in children are similar to that used in adults. The incidence of serious side effects in pediatric ambulatory continuous peripheral nerve block is extremely rare. When this is combined with the potential to increase patient and family satisfaction and decrease opioid-related side effects, ambulatory continuous peripheral nerve block become a compelling choice.
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Affiliation(s)
- Sible Antony
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Harshad Gurnaney
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Arjunan Ganesh
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Ogami K, Murata H, Sakai A, Sato S, Saiki K, Okamoto K, Manabe Y, Hara T, Tsurumoto T. Deep and superficial circumflex iliac arteries and their relationship to the ultrasound-guided femoral nerve block procedure: A cadaver study. Clin Anat 2017; 30:413-420. [PMID: 28192858 DOI: 10.1002/ca.22852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/03/2017] [Indexed: 12/25/2022]
Abstract
The in-plane lateral to medial approach is a standard technique for ultrasound-guided femoral nerve block (USG-FNB). The first bifurcation of the femoral artery, which consists of the deep artery of the thigh (DAT) or occasionally the lateral circumflex femoral artery (LCFA), is regarded as the distal border for this procedure. We sometimes detect arteries along the estimated needle trajectory for USG-FNB. The superficial (SCIA) and deep (DCIA) circumflex iliac arteries run laterally parallel to the inguinal ligament from the femoral or external iliac artery. The relationship between the SCIA and DCIA and other anatomical structures related to USG-FNB around the femoral triangle region was studied by gross anatomical examination of 100 formalin-fixed adult cadavers. At least one SCIA and one DCIA were identified around each femoral triangle; 81.8% of SCIA and 58% of DCIA originated from the femoral artery. All DCIA coursed between the fascia lata and fascia iliaca and 80% of SCIA penetrated the fascia lata. In 94% of femoral triangles, at least one arterial branch heading towards the lateral part of the thigh originated from the femoral artery from the level of the inguinal ligament to the first bifurcation of the femoral artery. The presence of SCIA and DCIA should be considered during USG-FNB using the in-plane lateral to medial approach to avoid inadvertently injuring them, as they are occasionally located along the presumed needle trajectory superficial to the fascia iliaca. Clin. Anat. 30:413-420, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Keiko Ogami
- Department of Macroscopic Anatomy, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Anesthesiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroaki Murata
- Department of Anesthesiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akiko Sakai
- Department of Anesthesiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Kazunobu Saiki
- Department of Macroscopic Anatomy, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keishi Okamoto
- Department of Macroscopic Anatomy, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshitaka Manabe
- Department of Oral Anatomy and Dental Anthropology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuya Hara
- Department of Anesthesiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshiyuki Tsurumoto
- Department of Macroscopic Anatomy, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Mudumbai SC, Walters TL, Howard SK, Kim TE, Lochbaum GM, Memtsoudis SG, Kain ZN, Kou A, King R, Mariano ER. The Perioperative Surgical Home model facilitates change implementation in anesthetic technique within a clinical pathway for total knee arthroplasty. Healthcare (Basel) 2016; 4:334-339. [DOI: 10.1016/j.hjdsi.2016.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/10/2016] [Accepted: 03/14/2016] [Indexed: 01/22/2023] Open
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Steffel L, Howard SK, Borg L, Mariano ER, Leng JC, Kim TE. Randomized comparison of popliteal-sciatic perineural catheter tip migration and dislocation in a cadaver model using two catheter designs. Korean J Anesthesiol 2016; 70:72-76. [PMID: 28184270 PMCID: PMC5296391 DOI: 10.4097/kjae.2017.70.1.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/02/2016] [Accepted: 09/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New catheter-over-needle (CON) technology for continuous peripheral nerve blockade has emerged, but its effect on the risk of perineural catheter tip dislocation is unknown. Less flexible catheters may be more likely to migrate away from the nerve with simulated patient movement. In the present study, we evaluated catheter tip migration between CON catheters and traditional catheter-through-needle (CTN) catheters during ultrasound-guided short-axis in-plane (SAX-IP) insertion. METHODS We evaluated the migration of popliteal-sciatic catheters in a prone, unembalmed male cadaver. Thirty catheter placement trials were divided randomly into two groups based on the catheter type: CON or CTN. A single anesthesiology resident placed the catheters by SAX-IP insertion, and the catheters were then examined by ultrasound before and after ipsilateral knee range of motion (ROM) exercises (0°-130° flexion). A blinded expert regional anesthesiologist performed caliper measurements on the ultrasound images before and after the ROM exercises. The primary outcome was the change in distance from the catheter tip to the center of the nerve (cm) between before and after the ROM exercises. RESULTS The change in the tip-to-nerve distance (median [10th-90th percentile]) was 0.06 (-0.16 to 0.23) cm for the CTN catheter and 0.00 (-0.12 to 0.69) for the CON catheter (P = 0.663). However, there was a statistically significant increase in dislocation out of the nerve compartment for the CON catheter (4/15; 0/15 for CTN) (P = 0.043). CONCLUSIONS Although the use of different catheter designs had no effect on the change in the measured migration distance of popliteal-sciatic catheters, 27% of the CON catheters were dislocated out of the nerve compartment. These results may influence the choice of catheter design when using SAX-IP perineural catheter insertion.
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Affiliation(s)
- Lauren Steffel
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA
| | - Steven K Howard
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Lindsay Borg
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jody C Leng
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - T Edward Kim
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Mudumbai SC, Ganaway T, Kim TE, Howard SK, Giori NJ, Shum C, Mariano ER. Can bedside patient-reported numbness predict postoperative ambulation ability for total knee arthroplasty patients with nerve block catheters? Korean J Anesthesiol 2016; 69:32-6. [PMID: 26885299 PMCID: PMC4754264 DOI: 10.4097/kjae.2016.69.1.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/08/2015] [Accepted: 07/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adductor canal catheters offer advantages over femoral nerve catheters for knee replacement patients because they produce less quadriceps muscle weakness; however, applying adductor canal catheters in bedside clinical practice remains challenging. There is currently no patient-reported outcome that accurately predicts patients' physical function after knee replacement. The present study evaluates the validity of a relatively new patient-reported outcome, i.e., a numbness score obtained using a numeric rating scale, and assesses its predictive value on postoperative ambulation. METHODS We conducted a retrospective cohort study pooling data from two previously-published clinical trials using identical research methodologies. Both studies recruited patients undergoing knee replacement; one studied adductor canal catheters while the other studied femoral nerve catheters. Our primary outcome was patient-reported numbness scores on postoperative day 1. We also examined postoperative day 1 ambulation distance and its association with postoperative numbness using linear regression, adjusting for age, body mass index, and physical status. RESULTS Data from 94 subjects were included (femoral subjects, n = 46; adductor canal subjects, n = 48). Adductor canal patients reported decreased numbness (median [10(th)-90(th) percentiles]) compared to femoral patients (0 [0-5] vs. 4 [0-10], P = 0.001). Adductor canal patients also ambulated seven times further on postoperative day 1 relative to femoral patients. There was a significant association between postoperative day 1 total ambulation distance and numbness (Beta = -2.6; 95% CI: -4.5, -0.8, P = 0.01) with R(2) = 0.1. CONCLUSIONS Adductor canal catheters facilitate improved early ambulation and produce less patient-reported numbness after knee replacement, but the correlation between these two variables is weak.
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Affiliation(s)
- Seshadri C Mudumbai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, CA, USA.; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, CA, USA
| | - Toni Ganaway
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, CA, USA.; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, CA, USA
| | - T Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, CA, USA.; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, CA, USA
| | - Steven K Howard
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, CA, USA.; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, CA, USA
| | - Nicholas J Giori
- Department of Orthopaedic Surgery, Stanford University School of Medicine, CA, USA.; Surgical Service, Orthopaedic Surgery Section, Veterans Affairs Palo Alto Health Care System, CA, USA
| | - Cynthia Shum
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, CA, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, CA, USA.; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, CA, USA
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Evidence Basis for Ultrasound Guidance for Lower-Extremity Peripheral Nerve Block. Reg Anesth Pain Med 2016; 41:261-74. [DOI: 10.1097/aap.0000000000000336] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Elsharkawy H, Maheshwari A, Farag E, Mariano ER, Rosenquist RW. Development of technologies for placement of perineural catheters. J Anesth 2015; 30:138-47. [DOI: 10.1007/s00540-015-2076-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
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Harrison TK, Kim TE, Howard SK, Funck N, Wagner MJ, Walters TL, Curtin C, Chang J, Ganaway T, Mariano ER. Comparative effectiveness of infraclavicular and supraclavicular perineural catheters for ultrasound-guided through-the-catheter bolus anesthesia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:333-340. [PMID: 25614407 DOI: 10.7863/ultra.34.2.333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Using a through-the-needle local anesthetic bolus technique, ultrasound-guided infraclavicular perineural catheters have been shown to provide greater analgesia compared to supraclavicular catheters. A through-the-catheter bolus technique, which arguably "tests" the anesthetic efficacy of the catheter before initiating an infusion, has been validated for infraclavicular catheters but not supraclavicular catheters. This study investigated the through-the-catheter bolus technique for supraclavicular catheters and tested the hypothesis that infraclavicular catheters provide faster onset of brachial plexus anesthesia. METHODS Preoperatively, patients were randomly assigned to receive either a supraclavicular or an infraclavicular catheter using an ultrasound-guided nonstimulating catheter insertion technique with a mepivacaine bolus via the catheter and ropivacaine perineural infusion initiated postoperatively. The primary outcome was time to achieve complete sensory anesthesia in the ulnar and median nerve distributions. Secondary outcomes included procedural time, procedure-related pain and complications, and postoperative pain, opioid consumption, sleep disturbances, and motor weakness. RESULTS Fifty patients were enrolled in the study; all but 2 perineural catheters were successfully placed per protocol. Twenty-one of 24 (88%) and 24 of 24 (100%) patients in the supraclavicular and infraclavicular groups, respectively, achieved complete sensory anesthesia by 30 minutes (P= .088). There was no difference in the time to achieve complete sensory anesthesia. Supraclavicular patients reported more sleep disturbances postoperatively, but there were no statistically significant differences in other outcomes. CONCLUSIONS Both supraclavicular and infraclavicular perineural catheters using a through-the-catheter bolus technique provide effective brachial plexus anesthesia.
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Affiliation(s)
- T Kyle Harrison
- Departments of Anesthesiology, Perioperative and Pain Medicine (T.K.H., T.E.K., S.K.H., N.F., M.J.W., T.L.W., T.G., E.R.M.) and Surgery, Division of Plastic and Reconstructive Surgery (C.C., J.C.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - T Edward Kim
- Departments of Anesthesiology, Perioperative and Pain Medicine (T.K.H., T.E.K., S.K.H., N.F., M.J.W., T.L.W., T.G., E.R.M.) and Surgery, Division of Plastic and Reconstructive Surgery (C.C., J.C.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Steven K Howard
- Departments of Anesthesiology, Perioperative and Pain Medicine (T.K.H., T.E.K., S.K.H., N.F., M.J.W., T.L.W., T.G., E.R.M.) and Surgery, Division of Plastic and Reconstructive Surgery (C.C., J.C.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Natasha Funck
- Departments of Anesthesiology, Perioperative and Pain Medicine (T.K.H., T.E.K., S.K.H., N.F., M.J.W., T.L.W., T.G., E.R.M.) and Surgery, Division of Plastic and Reconstructive Surgery (C.C., J.C.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Michael J Wagner
- Departments of Anesthesiology, Perioperative and Pain Medicine (T.K.H., T.E.K., S.K.H., N.F., M.J.W., T.L.W., T.G., E.R.M.) and Surgery, Division of Plastic and Reconstructive Surgery (C.C., J.C.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Tessa L Walters
- Departments of Anesthesiology, Perioperative and Pain Medicine (T.K.H., T.E.K., S.K.H., N.F., M.J.W., T.L.W., T.G., E.R.M.) and Surgery, Division of Plastic and Reconstructive Surgery (C.C., J.C.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Catherine Curtin
- Departments of Anesthesiology, Perioperative and Pain Medicine (T.K.H., T.E.K., S.K.H., N.F., M.J.W., T.L.W., T.G., E.R.M.) and Surgery, Division of Plastic and Reconstructive Surgery (C.C., J.C.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - James Chang
- Departments of Anesthesiology, Perioperative and Pain Medicine (T.K.H., T.E.K., S.K.H., N.F., M.J.W., T.L.W., T.G., E.R.M.) and Surgery, Division of Plastic and Reconstructive Surgery (C.C., J.C.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Toni Ganaway
- Departments of Anesthesiology, Perioperative and Pain Medicine (T.K.H., T.E.K., S.K.H., N.F., M.J.W., T.L.W., T.G., E.R.M.) and Surgery, Division of Plastic and Reconstructive Surgery (C.C., J.C.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Edward R Mariano
- Departments of Anesthesiology, Perioperative and Pain Medicine (T.K.H., T.E.K., S.K.H., N.F., M.J.W., T.L.W., T.G., E.R.M.) and Surgery, Division of Plastic and Reconstructive Surgery (C.C., J.C.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA.
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Comparison of catheter tip migration using flexible and stimulating catheters inserted into the adductor canal in a cadaver model. J Anesth 2014; 29:471-474. [DOI: 10.1007/s00540-014-1957-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 11/24/2014] [Indexed: 11/30/2022]
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Johns J, Harrison TK, Steffel L, Howard SK, Kim TE, Kou A, Mariano ER. A pilot in vitro evaluation of the "air test" for perineural catheter tip localization by a novice regional anesthesiologist. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2197-2200. [PMID: 25425379 DOI: 10.7863/ultra.33.12.2197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The "air test" is used clinically to infer perineural catheter location and has been recently evaluated for use by experts. However, its utility for practitioners with less experience is unknown. We tested the hypothesis that the air test, when performed by a novice regional anesthesiologist, will improve assessment of perineural catheter tip position in a validated porcine-bovine model and determined the test's positive and negative predictive values, sensitivity, and specificity for a novice. In contrast to the results of the expert study, the air test did not improve the novice's assessment of perineural catheter tip location over chance.
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Affiliation(s)
- Jason Johns
- Department of Anesthesiology, Perioperative and Pain Medicine, VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative and Pain Medicine, VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Lauren Steffel
- Department of Anesthesiology, Perioperative and Pain Medicine, VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Steven K Howard
- Department of Anesthesiology, Perioperative and Pain Medicine, VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - T Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Alex Kou
- Department of Anesthesiology, Perioperative and Pain Medicine, VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA.
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Abstract
Available evidence favoring the use of ultrasound for regional anesthesia is reviewed, updated, and critically assessed. Important outcome advantages include decreased time to block onset; decreased risk of local anesthetic systemic toxicity; and, depending on the outcome definition, increased block success rates. Ultrasound guidance, peripheral nerve blocks, and central neuraxial blocks are discussed.
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Affiliation(s)
- Francis V Salinas
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Avenue, Mailstop B2-AN, Seattle, WA 98101, USA.
| | - Neil A Hanson
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Avenue, Mailstop B2-AN, Seattle, WA 98101, USA
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Mariano ER, Kim TE, Wagner MJ, Funck N, Harrison TK, Walters T, Giori N, Woolson S, Ganaway T, Howard SK. A randomized comparison of proximal and distal ultrasound-guided adductor canal catheter insertion sites for knee arthroplasty. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1653-1662. [PMID: 25154949 DOI: 10.7863/ultra.33.9.1653] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Proximal and distal (mid-thigh) ultrasound-guided continuous adductor canal block techniques have been described but not yet compared, and infusion benefits or side effects may be determined by catheter location. We hypothesized that proximal placement will result in faster onset of saphenous nerve anesthesia, without additional motor block, compared to a distal technique. METHODS Preoperatively, patients receiving an ultrasound-guided nonstimulating adductor canal catheter for knee arthroplasty were randomly assigned to either proximal or distal insertion. A local anesthetic bolus was administered via the catheter after successful placement. The primary outcome was the time to achieve complete sensory anesthesia in the saphenous nerve distribution. Secondary outcomes included procedural time, procedure-related pain and complications, postoperative pain, opioid consumption, and motor weakness. RESULTS Proximal insertion (n = 23) took a median (10th-90th percentiles) of 12.0 (3.0-21.0) minutes versus 6.0 (3.0-21.0) minutes for distal insertion (n = 21; P= .106) to anesthetize the medial calf. Only 10 of 25 (40%) and 10 of 24 (42%) patients in the proximal and distal groups, respectively, developed anesthesia at both the medial calf and top of the patella (P= .978). Bolus-induced motor weakness occurred in 19 of 25 (76%) and 16 of 24 (67%) patients in the proximal and distal groups (P = .529). Ten of 24 patients (42%) in the distal group required intravenous morphine postoperatively, compared to 2 of 24 (8%) in the proximal group (P = .008), but there were no differences in other secondary outcomes. CONCLUSIONS Continuous adductor canal blocks can be performed reliably at both proximal and distal locations. The proximal approach may offer minor analgesic and logistic advantages without an increase in motor block.
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Affiliation(s)
- Edward R Mariano
- Departments of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.E.K., M.J.W., N.F., T.K.H., T.W., T.G., S.K.H.) and Orthopedic Surgery (N.G., S.W.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA.
| | - T Edward Kim
- Departments of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.E.K., M.J.W., N.F., T.K.H., T.W., T.G., S.K.H.) and Orthopedic Surgery (N.G., S.W.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Michael J Wagner
- Departments of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.E.K., M.J.W., N.F., T.K.H., T.W., T.G., S.K.H.) and Orthopedic Surgery (N.G., S.W.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Natasha Funck
- Departments of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.E.K., M.J.W., N.F., T.K.H., T.W., T.G., S.K.H.) and Orthopedic Surgery (N.G., S.W.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - T Kyle Harrison
- Departments of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.E.K., M.J.W., N.F., T.K.H., T.W., T.G., S.K.H.) and Orthopedic Surgery (N.G., S.W.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Tessa Walters
- Departments of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.E.K., M.J.W., N.F., T.K.H., T.W., T.G., S.K.H.) and Orthopedic Surgery (N.G., S.W.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Nicholas Giori
- Departments of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.E.K., M.J.W., N.F., T.K.H., T.W., T.G., S.K.H.) and Orthopedic Surgery (N.G., S.W.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Steven Woolson
- Departments of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.E.K., M.J.W., N.F., T.K.H., T.W., T.G., S.K.H.) and Orthopedic Surgery (N.G., S.W.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Toni Ganaway
- Departments of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.E.K., M.J.W., N.F., T.K.H., T.W., T.G., S.K.H.) and Orthopedic Surgery (N.G., S.W.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
| | - Steven K Howard
- Departments of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.E.K., M.J.W., N.F., T.K.H., T.W., T.G., S.K.H.) and Orthopedic Surgery (N.G., S.W.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA
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20
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Dinh VA, Farshidpanah S, Lu S, Stokes P, Chrissian A, Shah H, Giri P, Hecht D, Nguyen HB. Real-time sonographically guided percutaneous dilatational tracheostomy using a long-axis approach compared to the landmark technique. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1407-1415. [PMID: 25063406 DOI: 10.7863/ultra.33.8.1407] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Sonographic evaluation of neck anatomy before performing percutaneous dilatational tracheostomy (PDT) has been shown to predict PDT success. In this study, we compared the real-time, long-axis, in-plane approach to the traditional bronchoscopically guided landmark technique. METHODS Data were analyzed from a prospectively maintained PDT database at a university tertiary care medical intensive care unit. A convenience sample of adult patients requiring PDT for prolonged mechanical ventilation dependence was enrolled. Critical care fellows, under direct supervision of an attending intensivist, performed all PDTs. Tracheostomy performance from the sonographically guided and landmark techniques was compared. RESULTS Twenty-three patients were enrolled: 11 in the sonography group and 12 in the landmark group. Initial midline introducer needle puncture was achieved in 72.7% in the sonography group compared to 8.3% in the landmark group (P< .001). The mean number of introducer needle punctures ± SD was significantly lower in the sonography group compared to the landmark group (1.4 ± 0.7 versus 2.6 ± 0.9; P < .001). The total tracheostomy time was 11.4 ± 4.2 minutes in the sonography group versus 15.3 ± 6.8 minutes in the landmark group (P = .12). Sonography accurately predicted tracheal ring space insertion in 90.9% of patients. Procedural complications did not differ significantly between the groups. CONCLUSIONS Percutaneous dilatational tracheostomy under real-time sonographic guidance using a long-axis approach may increase the rate of midline punctures and decrease the number of needle punctures when compared to the landmark technique. Sonographic guidance can also help guide accurate and efficient placement of a tracheostomy tube into the desired tracheal ring space.
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Affiliation(s)
- Vi Am Dinh
- Department of Emergency Medicine (V.A.D., D.H., H.B.N.), Department of Medicine, Division of Pulmonary and Critical Care (V.A.D., S.F., A.C., H.S., P.G., D.H., H.B.N.), and School of Medicine (S.L., P.S.), Loma Linda University, Loma Linda, California USA.
| | - Siavash Farshidpanah
- Department of Emergency Medicine (V.A.D., D.H., H.B.N.), Department of Medicine, Division of Pulmonary and Critical Care (V.A.D., S.F., A.C., H.S., P.G., D.H., H.B.N.), and School of Medicine (S.L., P.S.), Loma Linda University, Loma Linda, California USA
| | - Samantha Lu
- Department of Emergency Medicine (V.A.D., D.H., H.B.N.), Department of Medicine, Division of Pulmonary and Critical Care (V.A.D., S.F., A.C., H.S., P.G., D.H., H.B.N.), and School of Medicine (S.L., P.S.), Loma Linda University, Loma Linda, California USA
| | - Phillip Stokes
- Department of Emergency Medicine (V.A.D., D.H., H.B.N.), Department of Medicine, Division of Pulmonary and Critical Care (V.A.D., S.F., A.C., H.S., P.G., D.H., H.B.N.), and School of Medicine (S.L., P.S.), Loma Linda University, Loma Linda, California USA
| | - Ara Chrissian
- Department of Emergency Medicine (V.A.D., D.H., H.B.N.), Department of Medicine, Division of Pulmonary and Critical Care (V.A.D., S.F., A.C., H.S., P.G., D.H., H.B.N.), and School of Medicine (S.L., P.S.), Loma Linda University, Loma Linda, California USA
| | - Harsh Shah
- Department of Emergency Medicine (V.A.D., D.H., H.B.N.), Department of Medicine, Division of Pulmonary and Critical Care (V.A.D., S.F., A.C., H.S., P.G., D.H., H.B.N.), and School of Medicine (S.L., P.S.), Loma Linda University, Loma Linda, California USA
| | - Paresh Giri
- Department of Emergency Medicine (V.A.D., D.H., H.B.N.), Department of Medicine, Division of Pulmonary and Critical Care (V.A.D., S.F., A.C., H.S., P.G., D.H., H.B.N.), and School of Medicine (S.L., P.S.), Loma Linda University, Loma Linda, California USA
| | - David Hecht
- Department of Emergency Medicine (V.A.D., D.H., H.B.N.), Department of Medicine, Division of Pulmonary and Critical Care (V.A.D., S.F., A.C., H.S., P.G., D.H., H.B.N.), and School of Medicine (S.L., P.S.), Loma Linda University, Loma Linda, California USA
| | - H Bryant Nguyen
- Department of Emergency Medicine (V.A.D., D.H., H.B.N.), Department of Medicine, Division of Pulmonary and Critical Care (V.A.D., S.F., A.C., H.S., P.G., D.H., H.B.N.), and School of Medicine (S.L., P.S.), Loma Linda University, Loma Linda, California USA
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Mudumbai SC, Kim TE, Howard SK, Workman JJ, Giori N, Woolson S, Ganaway T, King R, Mariano ER. Continuous adductor canal blocks are superior to continuous femoral nerve blocks in promoting early ambulation after TKA. Clin Orthop Relat Res 2014; 472:1377-83. [PMID: 23897505 PMCID: PMC3971247 DOI: 10.1007/s11999-013-3197-y] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoral continuous peripheral nerve blocks (CPNBs) provide effective analgesia after TKA but have been associated with quadriceps weakness and delayed ambulation. A promising alternative is adductor canal CPNB that delivers a primarily sensory blockade; however, the differential effects of these two techniques on functional outcomes after TKA are not well established. QUESTIONS/PURPOSES We determined whether, after TKA, patients with adductor canal CPNB versus patients with femoral CPNB demonstrated (1) greater total ambulation distance on Postoperative Day (POD) 1 and 2 and (2) decreased daily opioid consumption, pain scores, and hospital length of stay. METHODS Between October 2011 and October 2012, 180 patients underwent primary TKA at our practice site, of whom 93% (n = 168) had CPNBs. In this sequential series, the first 102 patients had femoral CPNBs, and the next 66 had adductor canal CPNBs. The change resulted from a modification to our clinical pathway, which involved only a change to the block. An evaluator not involved in the patients' care reviewed their medical records to record the parameters noted above. RESULTS Ambulation distances were higher in the adductor canal group than in the femoral group on POD 1 (median [10(th)-90(th) percentiles]: 37 m [0-90 m] versus 6 m [0-51 m]; p < 0.001) and POD 2 (60 m [0-120 m] versus 21 m [0-78 m]; p = 0.003). Adjusted linear regression confirmed the association between adductor canal catheter use and ambulation distance on POD 1 (B = 23; 95% CI = 14-33; p < 0.001) and POD 2 (B = 19; 95% CI = 5-33; p = 0.008). Pain scores, daily opioid consumption, and hospital length of stay were similar between groups. CONCLUSIONS Adductor canal CPNB may promote greater early postoperative ambulation compared to femoral CPNB after TKA without a reduction in analgesia. Future randomized studies are needed to validate our major findings. LEVEL OF EVIDENCE Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Seshadri C. Mudumbai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - T. Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Steven K. Howard
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - J. Justin Workman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Nicholas Giori
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA USA
| | - Steven Woolson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA USA
| | - Toni Ganaway
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Robert King
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Edward R. Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA USA ,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304 USA
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Edward Kim T, Howard SK, Funck N, Kyle Harrison T, Walters TL, Wagner MJ, Ganaway T, Mullens J, Lehnert B, Mariano ER. A randomized comparison of long-axis and short-axis imaging for in-plane ultrasound-guided popliteal-sciatic perineural catheter insertion. J Anesth 2014; 28:854-60. [DOI: 10.1007/s00540-014-1832-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 04/04/2014] [Indexed: 11/27/2022]
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Mariano ER, Yun RDH, Kim TE, Carvalho B. Application of echogenic technology for catheters used in ultrasound-guided continuous peripheral nerve blocks. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:905-911. [PMID: 24764346 DOI: 10.7863/ultra.33.5.905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Limited data exist regarding the echogenicity of perineural catheters, but visualization is crucial to ensure accurate placement and efficacy of the subsequent local anesthetic infusion. The objective of this study was to determine the comparative echogenicity of various regional anesthesia catheters. In an in vitro porcine-bovine model, we compared the echogenic qualities of 3 commercially available regional anesthesia catheters and 1 catheter under development to optimize echogenicity. Outcomes included visual echogenicity ranking, image quality, and scanning time, as assessed by 2 blinded investigators. The experimental catheter was found to be more echogenic than 2 of the 3 comparators.
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Affiliation(s)
- Edward R Mariano
- MAS, Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, 3801 Miranda Ave, 112A, Palo Alto, CA 94304 USA.
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Merritt CK, Mariano ER, Kaye AD, Lissauer J, Mancuso K, Prabhakar A, Urman RD. Peripheral nerve catheters and local anesthetic infiltration in perioperative analgesia. Best Pract Res Clin Anaesthesiol 2014; 28:41-57. [DOI: 10.1016/j.bpa.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 02/09/2014] [Accepted: 02/19/2014] [Indexed: 11/16/2022]
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