Training requirements for peripheral nerve blocks.

Purpose Of Review: To review the current recommendations and literature on training in regional anesthesia and suggest an improved model to prepare graduating residents better in the practice of regional anesthesia.

Recent Findings: Patient satisfaction, a growing demand for cost-effective anesthesia, and a favorable postoperative recovery profile have all resulted in the growing demand for regional anesthesia. However, it has been well established that the current teaching of regional anesthesia is suboptimal.

Neurologic complication after anterior sciatic nerve block.

The lack of reported complications related to lower extremity peripheral nerve blocks (PNBs) may be related to the relatively infrequent application of these techniques and to the fact that most such events go unpublished. Our current understanding of the factors that lead to neurologic complications after PNBs is limited. This is partly the result of our inability to conduct meaningful retrospective studies because of a lack of standard and objective monitoring and documentation procedures for PNBs.

Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy.

It has been suggested that use of peripheral nerve blocks (PNBs) may have some potential benefits in the outpatient setting. There have been no studies specifically comparing PNBs performed with short-acting local anesthetics with general anesthesia (GA) in patients undergoing outpatient knee surgery. We hypothesized that a combination of lumbar plexus and sciatic blocks using a short-acting local anesthetic will result in shorter time-to-discharge-home as compared with GA.

A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist day-case surgeries.

Background: General anesthesia (GA) and brachial plexus block have been used successfully for surgery on the upper extremities. Controversy exists as to which method is more suitable in outpatients undergoing hand and wrist surgery. The authors hypothesized that infraclavicular brachial plexus block (INB) performed with a short-acting local anesthetic would result in shorter time to discharge home as compared with "fast-track" GA.

Electrical nerve localization: effects of cutaneous electrode placement and duration of the stimulus on motor response.

Background: Recommendations regarding the technical aspects of nerve stimulator-assisted nerve localization are conflicting. The objectives of this study were to determine whether the placement of the cutaneous electrode affects nerve stimulation and to determine the duration and intensity of an electrical stimulus that allows nerve stimulation with minimal discomfort.

Methods: Ten healthy volunteers underwent an interscalene and a femoral nerve block.

Injection pressures by anesthesiologists during simulated peripheral nerve block.

Background And Objectives: Anesthesiologists typically rely on a subjective evaluation ("syringe feel") of possible abnormal resistance to injection while performing a peripheral nerve block (PNB). A greater force required to perform the injection is believed to be associated with intraneural injection. The hypothesis of this study is that anesthesiologists vary in their perception of "normal" injection force, that the syringe feel method is inconsistent in estimating resistance, and that needle design may affect the injection force.

Painful paresthesiae are infrequent during brachial plexus localization using low-current peripheral nerve stimulation.

Background: Considerable controversy exists over the relationship of paresthesia to nerve stimulation. The purpose of this study was to determine the frequency with which patients report paresthesia at the point that an acceptable motor response is obtained to low-intensity current electrical stimulation.

Methods: Low-intensity current nerve stimulation (0.

A comparison of intertendinous and classical approaches to popliteal nerve block using magnetic resonance imaging simulation.

Unlabelled: The classical approach to sciatic nerve block in the popliteal fossa (popliteal block) often requires multiple attempts to localize the sciatic nerve. Recently, it has been suggested that an intertendinous approach to popliteal block may result in a more consistent localization of the sciatic nerve. In the current study, we compared anatomical landmarks for the intertendinous and classical approaches to popliteal block with respect to the accuracy in localizing the sciatic nerve using magnetic resonance imaging simulation.