Evaluation of a New Needle Guidance System for Ultrasound: Results of a Prospective, Randomized, Blinded Study.

Background And Objectives: Accurate needle control during ultrasound (US)-guided nerve blocks may be an elusive goal for the anesthesiologist. Despite modifications to increase echogenicity, needle visibility still requires precise alignment within the transducer beam. In this study, we evaluated a magnetically guided ultrasound (MGU) system that produces a real-time, graphic display of the needle position and trajectory that is independent of the US beam.

Local anesthetic injection deep to the fascia iliaca at the level of the inguinal ligament: the pattern of distribution and effects on the obturator nerve.

Study Objective: The femoral, lateral femoral cutaneous, and obturator nerves (ONs) can reportedly be blocked using a single-injection deep to the fascia iliaca (FI) at the level of the inguinal ligament. Two commonly used methods (the FI compartment and 3-in-1 blocks) have produced inconsistent results with respect to local anesthetic distribution and effect on the ON. To date, no study of either method has been performed using advanced imaging techniques to document both needle placement and local anesthetic distribution.

Serotonin syndrome manifesting as patient movement during total intravenous anesthesia with propofol and remifentanil.

A patient who manifested signs of serotonin syndrome during an intravenous anesthetic with remifentanil and propofol is presented. The patient displayed lower extremity clonus, nystagmus, and diaphoresis. At the time of surgery, the patient was being treated with fluoxetine (a selective serotonin reuptake inhibitor).

Anatomic changes in the inguinal region after hip arthroscopy: implications for femoral nerve block.

Patients may experience significant pain after hip arthroscopy. Two patients who experienced severe pain after arthroscopic hip surgery, despite receiving multimodal pharmacologic therapy, are presented. In both cases, ultrasound-guided femoral nerve block provided excellent analgesia.

Three-times-daily subcutaneous unfractionated heparin and neuraxial anesthesia: a retrospective review of 928 cases.

Background And Objectives: Subcutaneous (SC) unfractionated heparin (UFH) administered 3 times daily (TID) is widely used for venous thromboembolism prophylaxis in the perioperative period. There are no data in the literature regarding the incidence of adverse outcomes with neuraxial analgesia in the setting of this regimen. In this retrospective review, we report the incidence of untoward events related to anticoagulation with SC UFH TID in patients with indwelling epidural catheters.

Improving individual measurement of postoperative pain: the pain trajectory.

Unlabelled: The purpose of this study was to demonstrate a method for increasing the precision and information yield of postoperative pain assessment. We recorded pain intensity ratings over 6 days after surgery in 502 elective surgery patients and examined individual pain trajectories. A linear fit of an individual patient's scores defines a trajectory with two features: (1) the intercept or initial pain intensity; and (2) the slope, or rate of pain resolution.

Ambulatory anesthesia and regional catheters: when and how.

Several clinical trials have demonstrated the superiority of continuous peripheral nerve block compared with traditional opioid-based analgesia. The ability to provide safe and effective continuous peripheral nerve block at home is an attractive alternative to opioid-based analgesia with its related side effects. In this article, the practical issues related to catheter use in the ambulatory setting are discussed.

Interscalene block for postoperative analgesia using only ultrasound guidance: the outcome in 200 patients.

Study Objective: To report the results of single and continuous interscalene blocks (ISB) performed using ultrasound (US) guidance only.

Design: Prospective, observational study.

Setting: Operating room of a university-affiliated orthopaedic hospital.

Delaware's Wellness Program: Motivating Employees Improves Health and Saves Money.

Background: Every year, employers around the country evaluate their company benefits package in the hopes of finding a solution to the ever-rising cost of health insurance premiums. For many business executives, the only logical choice is to pass along those costs to the employee.

Objectives: As an employer, our goal in Delaware has always been to come up with innovative solutions to drive down the cost of health insurance premiums while encouraging our employees to take responsibility for their own health and wellness by living a healthy and active lifestyle, and provide them with the necessary tools.

A novel approach for assessing catheter position after ultrasound-guided placement of continuous interscalene block.

The increasing use of ultrasound has allowed anesthesiologists to perform nerve blocks with a high success rate and without nerve stimulation or eliciting a paresthesia. The ability to visualize peripheral nerve catheters using ultrasound is limited. We present a novel method to confirm the position of an interscalene catheter tip using injection of agitated contrast.

Racial and gender differences in susceptibility to tobacco smoke among patients with chronic obstructive pulmonary disease.

Background: Although chronic obstructive pulmonary disease (COPD) has been considered a disease of Caucasian men, recent data show mortality rising faster among women and African-Americans. Some have suggested these groups are more susceptible to tobacco smoke. We examined this issue in our own population of COPD patients.

Preoperative "fentanyl challenge" as a tool to estimate postoperative opioid dosing in chronic opioid-consuming patients.

Unlabelled: When opioids are used for postoperative pain control, it is useful to define the dose-response relationship for analgesia and respiratory depression. We studied 20 chronically opioid-consuming patients having elective multilevel spine fusion. Preoperatively, each patient received a fentanyl infusion of 2 microg x kg(-1) x min(-1) until the respiratory rate was <5 breaths/min.

Postoperative care of the chronic opioid-consuming patient.

Recently, there has been a significant increase in the use of opioid analgesics for chronic pain in the outpatient setting. As a result, anesthesiologists are commonly presented with the dilemma of treating acute postoperative pain in patients who do not receive adequate analgesia with conventional doses of opioid. This article presents a practical approach to treating postoperative pain in the chronic opioid-consuming patient.

Preoperative fentanyl infusion with pharmacokinetic simulation for anesthetic and perioperative management of an opioid-tolerant patient.

Unlabelled: For opioid-tolerant patients, conventional patient-controlled analgesia dosing may be ineffective. We present a cardiac surgery patient with a history of significant opioid tolerance and prior episodes of severe postoperative pain. Using the patient's response to a large-dose fentanyl infusion in conjunction with a pharmacokinetic simulation, effective intraoperative and postoperative fentanyl plasma concentrations were achieved.