Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks.

Background: Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks.

Methods: We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques.

Novel use of continuous pericapsular nerve group (PENG) block technique for traumatic superior and inferior pubic rami fractures: a case report.

Background: Pubic rami fractures are painful injuries more commonly seen in the elderly with osteoporosis after high velocity trauma. In the most cases, management is conservative and non-operative with the goal to provide optimal pain relief to facilitate early mobilization and hospital discharge. Unfortunately, opioids remain the mainstay analgesic option and regional anesthesia techniques are limited but may include lumbar epidural anesthesia.

Psychological interventions to reduce postoperative pain and opioid consumption: a narrative review of literature.

Background: Evidence suggests that over half of patients undergoing surgical procedures suffer from poorly controlled postoperative pain. In the context of an opioid epidemic, novel strategies for ameliorating postoperative pain and reducing opioid consumption are essential. Psychological interventions defined as strategies targeted towards reducing stress, anxiety, negative emotions and depression via education, therapy, behavioral modification and relaxation techniques are an emerging approach towards these endpoints.

Ultrasound-guided regional anesthesia: feasibility and effectiveness of teaching via telesimulation in Ethiopia.

Background: Acute pain management in resource-poor countries remains a challenge. Ultrasound-guided regional anesthesia is a cost-effective way of delivering analgesia in these settings. However, for financial and logistical reasons, educational workshops are inaccessible to many physicians in these environments.

Effect of vasopressor use on digit survival after replantation and revascularization-A large retrospective cohort study.

Purpose: Despite the common use of intraoperative vasopressors in hand microsurgery, the association between intraoperative vasopressor use and digital replant failure has not yet been examined. Our study aims to examine the association between intraoperative vasopressor use (phenylephrine and/or ephedrine) and postoperative digital failure of replanted or revascularized digits.

Methods: All patients from a single tertiary hand center who underwent unilateral digital replantation or revascularization procedures between 2005 and 2016 were included in this retrospective cohort study.

A Virtual Reality Simulation Model of Spinal Ultrasound: Role in Teaching Spinal Sonoanatomy.

Background And Objectives: Ultrasound assessment of the lumbar spine improves the success of spinal and epidural anesthesia, especially for patients with underlying difficult anatomy. To assist with the teaching and learning of ultrasound-guided neuraxial anesthesia, we have created an online interactive educational model (http://www.usra.

Is Ultrasound a Valid and Reliable Imaging Modality for Airway Evaluation?: An Observational Computed Tomographic Validation Study Using Submandibular Scanning of the Mouth and Oropharynx.

Objectives: Ultrasound (US) imaging of the airway may be useful in predicting difficulty of airway management (DAM); but its use is limited by lack of proof of its validity and reliability. We sought to validate US imaging of the airway by comparison to CT-scan, and to assess its inter- and intra-observer reliability. We used submandibular sonographic imaging of the mouth and oropharynx to examine how well the ratio of tongue thickness to oral cavity height correlates with the ratio of tongue volume to oral cavity volume, an established tomographic measure of DAM.

The future of regional anesthesia education: lessons learned from the surgical specialty.

Purpose: Application of ultrasound in regional anesthesia has now become the standard of care and its use has shown to reduce complications. Nevertheless, gaining expertise in ultrasound-guided regional anesthesia requires the acquisition of new cognitive and technical skills. In addition, due to a reduction in resident working hours and enforcement of labour laws and directives across various states and countries, trainees perform and witness fewer procedures.

The Nerves of the Adductor Canal and the Innervation of the Knee: An Anatomic Study.

Background And Objectives: Adductor canal block contributes to analgesia after total knee arthroplasty. However, controversy exists regarding the target nerves and the ideal site of local anesthetic administration. The aim of this cadaveric study was to identify the trajectory of all nerves that course in the adductor canal from their origin to their termination and describe their relative contributions to the innervation of the knee joint.

IV and Perineural Dexmedetomidine Similarly Prolong the Duration of Analgesia after Interscalene Brachial Plexus Block: A Randomized, Three-arm, Triple-masked, Placebo-controlled Trial.

Background: Perineural and IV dexmedetomidine have each been suggested to prolong the duration of analgesia when administered in conjunction with peripheral nerve blocks. In the first randomized, triple-masked, placebo-controlled trial to date, the authors aimed to define and compare the efficacy of perineural and IV dexmedetomidine in prolonging the analgesic duration of single-injection interscalene brachial plexus block (ISB) for outpatient shoulder surgery.

Methods: Ninety-nine patients were randomized to receive ISB using 15 ml ropivacaine, 0.

An Expedited Care Pathway with Ambulatory Brachial Plexus Analgesia Is a Cost-effective Alternative to Standard Inpatient Care after Complex Arthroscopic Elbow Surgery: A Randomized, Single-blinded Study.

Background: Common standard practice after complex arthroscopic elbow surgery includes hospital admission for 72 h. The authors hypothesized that an expedited care pathway, with 24 h of hospital admission and ambulatory brachial plexus analgesia and continuous passive motion at home, results in equivalent elbow range of motion (ROM) 2 weeks after surgery compared with standard 72-h hospital admission.

Methods: A randomized, single-blinded study was conducted after obtaining approval from the research ethics board.

Point-of-care ultrasound defines gastric content and changes the anesthetic management of elective surgical patients who have not followed fasting instructions: a prospective case series.

Purpose: Pulmonary aspiration of gastric contents is a major cause of anesthesia morbidity and mortality. Point-of-care gastric ultrasound provides information regarding the type and volume of gastric content. The hypothesis of this prospective cohort study was that the addition of point-of-care gastric ultrasound to standard patient assessment results in changes in anesthetic management in at least 30% of elective surgical patients who do not follow fasting instructions.

Novice performance of ultrasound-guided needling skills: effect of a needle guidance system.

Background And Objectives: Ultrasound-guided needle placement is a widely used technical skill that can be challenging to learn. The SonixGPS is a novel ultrasound needle-tracking system that has the potential to improve performance over traditional ultrasound systems. The objective of our study was to determine if the use of the SonixGPS ultrasound system improves performance of novice practitioners in ultrasound-guided needle placement compared with conventional ultrasound in the out-of-plane approach on a simulation model.

A valid and reliable assessment tool for remote simulation-based ultrasound-guided regional anesthesia.

Background And Objectives: The purpose of this study was to establish construct and concurrent validity and interrater reliability of an assessment tool for ultrasound-guided regional anesthesia (UGRA) performance on a high-fidelity simulation model.

Methods: Twenty participants were evaluated using a Checklist and Global Rating Scale designed for assessing any UGRA block. The participants performed an ultrasound-guided supraclavicular brachial plexus block on both a patient and a simulator.

Tension Pneumothorax as a Complication of Inadvertent Pleural Tears During Posterior Spinal Surgery.

Objective: To review and expose the occurrences of tension pneumothorax as a result of pleural tear during posterior spinal surgery.

Methods: Intraoperative reports were retrospectively reviewed for 2 patients who underwent posterior spinal fusion and experienced pleural tear and subsequent tension pneumothorax. Surgical decisions for recognition and treatment were also reviewed.

Continuous infraclavicular brachial plexus blockade: effect on survival of replanted digits.

In replantation surgery, the use of continuous brachial plexus blockade (CBPB) is popular as it improves postoperative analgesia and vascular flow. The aim of our study was to determine whether CBPB may affect the odds of survivability of replanted digit(s). A four-year retrospective chart review was performed and various parameters affecting replant survival were examined.

The use of an online three-dimensional model improves performance in ultrasound scanning of the spine: a randomized trial.

Purpose: The use of ultrasound for neuraxial blockade is a new application of technology that is rapidly becoming accepted as a standard of care. This new skill has shown to improve success, but it is a challenge to teach. To assist with teaching the use of ultrasound in regional anesthesia of the lumbar spine, we have developed an interactive educational model ( http://pie.

Real-time ultrasound-guided spinal anesthesia using the SonixGPS® needle tracking system: a case report.

Purpose: The SonixGPS® is an electromagnetic needle tracking system for ultrasound-guided needle intervention. Both current and predicted needle tip position are displayed on the ultrasound screen in real-time, facilitating needle-beam alignment and guidance to the target. This case report illustrates the use of the SonixGPS system for successful performance of real-time ultrasound-guided spinal anesthesia in a patient with difficult spinal anatomy.

Ultrasound-guided regional anesthesia performance in the early learning period: effect of simulation training.

Background And Objectives: Success in performing ultrasound-guided peripheral nerve blockade (PNB) demands sound knowledge of sonoanatomy, good scanning techniques, and proper hand-eye coordination. The objectives of our study were to evaluate whether simulator training aids success of novice operators in ultrasound-guided PNB and to determine what number of procedures is required to attain proficiency.

Methods: Twenty Postgraduate Year 2 anesthesiology residents with no previous experience in ultrasound-guided PNB were randomly assigned into 2 groups.

Ondine's curse: anesthesia for laparoscopic implantation of a diaphragm pacing stimulation system.

Purpose: Central alveolar hypoventilation syndrome (CAHS) is a rare disease characterized by the loss of autonomic control of breathing. This condition causes hypoventilation and obstruction during sleep. Throughout their lives, these patients require ventilatory assistance by means of positive pressure ventilation to their lungs via mask, tracheotomy, or other means, such as phrenic nerve pacers.