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.

Varicella-Zoster Virus Reactivation and Increased Vascular Risk in People Living with HIV: Data from a Retrospective Cohort Study.

Background: The increased vascular risk associated with varicella-zoster virus (VZV) reactivation is extensively established in the general population. This retrospective cohort study investigates whether this observation holds for People Living with HIV (PLWH), a group already confronting heightened cardiovascular risk.

Methods: Among PLWH who initiated antiretroviral therapy (ART) at our center and have been under our care for >24 months since 1st January 2005, individuals with a history of herpes zoster (HZ) were identified, and their features were compared with those of PLWH with no history of HZ.

Paravertebral block: anatomy and relevant safety issues.

Paravertebral block, especially thoracic paravertebral block, is an effective regional anesthetic technique that can provide significant analgesia for numerous surgical procedures, including breast surgery, pulmonary surgery, and herniorrhaphy. The technique, although straightforward, is not devoid of potential adverse effects. Proper anatomic knowledge and adequate technique may help decrease the risk of these effects.

Airway management in anesthesia for thoracic surgery: a "real life" observational study.

Background: One-lung ventilation (OLV) in thoracic anesthesia is required to provide good surgical exposure. OLV is commonly achieved through a double lumen tube (DLT) or a bronchial blocker (BB). Malposition is a relevant issue related to these devices use.

Refining a great idea: the consolidation of PECS I, PECS II and serratus blocks into a single thoracic fascial plane block, the SAP block.

The popularity of ultrasound-guided nerve blocks has impacted the practice of regional anesthesia in profound ways, improving some techniques and introducing new ones. Some of these new nerve blocks are based on the concept of fascial plane blocks, in which the local anesthetic is injected into a plane instead of around a specific nerve. Pectoralis muscles (PECS) and serratus blocks, most commonly used for post op analgesia after breast surgery, are good examples.

Functional anatomy of the nerve and optimal placement of the needle for successful (and) safe nerve blocks.

Purpose Of Review: Summarize the current thinking concerning the clinically relevant aspects of nerve anatomy and best injection sites for nerve blocks.

Recent Findings: The widespread use of ultrasound in regional anesthesia has changed the practice of regional anesthesia and created new possibilities. Among them is the ability to identify fascial planes, and this has become the basis for a new group of blocks, the fascial plane blocks.

Interfering trajectories in experimental quantum-enhanced stochastic simulation.

Simulations of stochastic processes play an important role in the quantitative sciences, enabling the characterisation of complex systems. Recent work has established a quantum advantage in stochastic simulation, leading to quantum devices that execute a simulation using less memory than possible by classical means. To realise this advantage it is essential that the memory register remains coherent, and coherently interacts with the processor, allowing the simulator to operate over many time steps.

Ultrasound-Guided Interscalene Block: Reevaluation of the "Stoplight" Sign and Clinical Implications.

Background And Objectives: The "stoplight" sign is a frequently described image during ultrasound-guided interscalene block, referring to 3 hypoechoic structures found between the anterior and middle scalene muscles.This study was designed to establish the ultrasound-anatomy correlation of this sign and to find any other anatomical features within the roots that could help with the interpretation of the ultrasound images obtained at the interscalene level.

Methods: We performed 20 dissections of the brachial plexus in 10 embalmed human cadavers and systematically analyzed and measured the roots of C5 to C7 and then correlated these findings with ultrasonographic images on file.

Innervation of the Anterior Capsule of the Human Knee: Implications for Radiofrequency Ablation.

Background And Objectives: Chronic knee pain is common in all age groups. Some patients who fail conservative therapy benefit from radiofrequency neurotomy. Knowledge of the anatomy is critical to ensure a successful outcome.

A no-go result on the purification of quantum states.

The information encoded in a quantum system is generally spoiled by the influences of its environment, leading to a transition from pure to mixed states. Reducing the mixedness of a state is a fundamental step in the quest for a feasible implementation of quantum technologies. Here we show that it is impossible to "transfer" part of such mixedness to a "trash" system without losing some of the initial information.

The sensory territory of the lateral cutaneous nerve of the thigh as determined by anatomic dissections and ultrasound-guided blocks.

Background And Objectives: A femoral block sometimes fails to provide complete sensory anesthesia of the anterior aspect of middle and distal thigh, and a block of the lateral cutaneous nerve of the thigh (LCN) is often necessary to supplement it. The goal of this study was to demonstrate, both in the anatomy laboratory and in the clinical setting, a possible contribution of the LCN to the innervation of the anterior thigh.

Methods: This was a prospective, observational study, including anatomic dissections and a clinical section in which 22 patients received an ultrasound-guided block of the LCN.

Ultrasound-guided ankle block for forefoot surgery: the contribution of the saphenous nerve.

Background: Ankle blocks typically include the block of 5 nerves, the 4 branches that trace their origin back to the sciatic nerve plus the saphenous nerve (SaN). The sensory area of the SaN in the foot is variable. Based on our clinical experience, we decided to study the sensory distribution of the SaN in the foot and determine whether the block of this nerve is necessary as a component of an ultrasound-guided ankle block for bunion surgery.

Real-time three-dimensional ultrasound-assisted axillary plexus block defines soft tissue planes.

Two-dimensional (2D) ultrasound is commonly used for regional block of the axillary brachial plexus. In this technical case report, we described a real-time three-dimensional (3D) ultrasound-guided axillary block. The difference between 2D and 3D ultrasound is similar to the difference between plain radiograph and computer tomography.

Upper extremity regional anesthesia: essentials of our current understanding, 2008.

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.

Gross anatomy of the brachial plexus sheath in human cadavers.

Background And Objectives: Major nerves and vessels run alongside each other in a "neurovascular bundle" kept together by connective tissue that is often referred to by anatomists, surgeons, and anesthesiologists as the "sheath." Our goal was to macroscopically demonstrate the brachial plexus sheath in embalmed and fresh cadaver dissections.

Methods: Systematic dissections were performed on 11 embalmed cadavers (6 females and 5 males), plus one fresh, unembalmed male cadaver.

A subgluteal approach to the sciatic nerve in adults at 10 cm from the midline.

Background And Objectives: In 2003 we introduced the concept of a sciatic nerve block performed in the midgluteal area at a fixed distance from the midline in all adults regardless of gender and/or body size. The anatomic basis for that study suggested that a subgluteal block could also be accomplished in a similar fashion.

Methods: After informed consent, 20 patients were prospectively recruited.