Ultrasound-Guided Out-of-Plane vs. In-Plane Interscalene Catheters: A Randomized, Prospective Study.

Background: Continuous interscalene blocks provide excellent analgesia after shoulder surgery. Although the safety of the ultrasound-guided in-plane approach has been touted, technical and patient factors can limit this approach. We developed a caudad-to-cephalad out-of-plane approach and hypothesized that it would decrease pain ratings due to better catheter alignment with the brachial plexus compared to the in-plane technique in a randomized, controlled study.

Regional anesthesia-analgesia: relationship to cancer recurrence and infection.

The basic principles of perioperative immune function with regard to cancer recurrence and infection are reviewed. The role of regional anesthesia-analgesia in preservation of immune function and available published data are discussed.

Acute pain management in the postanesthesia care unit.

Pain management in the postanesthesia care unit (PACU) is continually evolving, with several new nonopioids expanding the list of available agents. Pain in the PACU is not an inevitable outcome of surgery. With careful planning, multimodal analgesic techniques instituted preoperatively will reduce pain in the PACU.

A comparison of cardiologist and noncardiologist use of echocardiograms: implications for containing health care costs.

Echocardiography enables physicians to examine the heart noninvasively and provides a comprehensive evaluation of the cardiovascular system. However, because it is a relatively expensive procedure compared to an ECG or X-ray, it is crucial that "echo" be utilized appropriately and judiciously. Using a retrospective chart review, we sought to determine whether there are differences in concordance between the diagnoses and echo findings of cardiologists and those of other physicians.