Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block.

Background: Continuous peripheral nerve catheters (PNCs) have been shown to provide superior postoperative analgesia, decrease opioid consumption, and improve patient satisfaction compared with single injection techniques. In order to achieve success and reliability, accurate catheter positioning is an essential element of PNC placement. An agitated solution of normal saline, D5W, or a local anesthetic solution can be produced by the introduction of air to the injectate, creating air bubbles that can enhance ultrasonographic visualization and possibly improve block success.

Comprehensive Analysis of 13,897 Consecutive Regional Anesthetics at an Ambulatory Surgery Center.

Objective: The authors investigated a wide range of perioperative outcome measures in the context of a robust regional anesthesia practice.

Design: Comprehensive review of a prospectively collected six-year database.

Setting: Freestanding, academic ambulatory surgery center.

Duration of upper and lower extremity peripheral nerve blockade is prolonged with dexamethasone when added to ropivacaine: a retrospective database analysis.

Background: Dexamethasone, when added to local anesthetics, has been shown to prolong the duration of peripheral nerve blocks; however, there are limited studies utilizing large numbers of patients. The purpose of this study was to examine the effect of adding dexamethasone to ropivacaine on duration of nerve blocks of the upper and lower extremity.

Methods: We reviewed 1,040 patient records collected in an orthopedic outpatient surgery center that had received an upper or lower extremity peripheral nerve block with ropivacaine 0.

The impact of peripheral nerve techniques on hospital stay following major orthopedic surgery.

Objective: To determine the impact of regional anesthesia on hospital stay for selected orthopedic procedures compared with traditional pain control modalities.

Design: In an era of an increasing volume of orthopedic surgeries, pain modalities that can optimize patient care while minimizing hospital length of stay can have an impact on reducing hospital costs as well as increasing patient satisfaction and improving patient outcomes. Previous studies have shown the potential benefits of regional anesthesia over traditional intravenous (IV) narcotics in meeting these goals in selected orthopedic procedures.

Continuous peripheral nerve block catheter infections in combat-related injuries: a case report of five soldiers from Operation Enduring Freedom/Operation Iraqi Freedom.

Design: Case series.

Setting: Military medical facility providing acute care for soldiers injured while fighting in the war in Iraq and Afghanistan.

Objective: To report a series of infections related to use of continuous peripheral nerve catheters for postoperative pain control in the military polytraumatic setting.

Brachial plexus entrapment of interscalene nerve catheter after uncomplicated ultrasound-guided placement.

We report on the case of an entrapped interscalene nerve catheter in a 46-year-old male undergoing left shoulder arthroscopic lysis of adhesions for a frozen shoulder. The catheter was placed under ultrasound guidance without any apparent complications. The continuous interscalene nerve block was successfully used as the primary anesthetic and for postoperative pain management.

The evolution of pain management in the critically ill trauma patient: Emerging concepts from the global war on terrorism.

Background: The evolution of military medical care to manage polytrauma, critically ill-wounded warriors from the greater war on terrorism has been accompanied by significant changes in the diagnosis, management, and modulation of acute and chronic trauma-related pain. A paradigm shift in pain management includes early treatment of pain at the point of injury and throughout the continuum of care with a combination of standard and novel therapeutic interventions. These concepts are important for all critical care providers because they translate to most critically ill patients, including those resulting from natural disasters.

Peripheral nerve blocks and anesthesia of the hand.

Regional anesthesia of the hand can be used in a vast array of hand injuries and minor operations. Local infiltration techniques require multiple injections and higher doses of anesthetic the that make them less preferable to peripheral nerve blocks. Regional anesthesia can be safe and effective as long as the provider has a firm understanding of the anatomy and technique.