Effect of combining peri-hamstring injection or anterior obturator nerve block on the analgesic efficacy of adductor canal block for anterior cruciate ligament reconstruction: a randomised controlled trial.

Background: Pain after anterior cruciate ligament reconstruction (ACLR) with autologous hamstring graft can be attributed to both arthroscopic surgery and the graft donor site. This study investigated whether donor site pain control was superior with the addition of either peri-hamstring injection or anterior division obturator nerve block in comparison with adductor canal block (ACB) alone.

Methods: Patients scheduled to undergo knee arthroscopy with ACLR using a graft from the ipsilateral hamstring were randomised to one of three groups.

Bilateral Thoracic Paravertebral Blocks Compared to Thoracic Epidural Analgesia After Midline Laparotomy: A Pragmatic Noninferiority Clinical Trial.

Background: Bilateral paravertebral block (PVB) is a suitable alternative to thoracic epidural analgesia (TEA) for abdominal surgeries. This randomized clinical trial aims to determine if PVB is noninferior to TEA in terms of analgesia after midline laparotomy.

Methods: Seventy American Society of Anesthesiologists (ASA) class I-III patients undergoing a laparotomy through a midline incision were randomized to receive either TEA (TEA group) or continuous bilateral PVB (PVB group) as a part of a multimodal analgesia regimen in an open-label design.

Development and Evaluation of an Augmented Reality Ultrasound Guidance System for Spinal Anesthesia: Preliminary Results.

Applications of ultrasound guidance for epidural injections are hindered by poor needle and epidural space visualization. This work presents an augmented reality (AR) ultrasound guidance system that addresses challenges in both needle visualization during navigation and epidural space identification for needle positioning. In this system, (i) B-mode ultrasound and the needle are visualized in a 3-D AR environment for improved navigation, and (ii) A-mode ultrasound, obtained from a custom-made single-element transducer housed at the needle tip, is used to identify the epidural space for improved needle positioning.

Ultrasound-guided lateral-medial transmuscular quadratus lumborum block for analgesia following anterior iliac crest bone graft harvesting: a clinical and anatomical study.

Background: The anterior iliac crest (AIC) is one of the most common sites for harvesting autologous bone, but the associated postoperative pain can result in significant morbidity. Recently, the transmuscular quadratus lumborum block (TQL) has been described to anesthetize the thoraco-lumbar nerves. This study utilizes a combination of cadaveric models and clinical case studies to evaluate the dermatomal coverage and analgesic utility of TQL for AIC bone graft donor site analgesia.

Determination of ED50 and ED95 of 0.5% Ropivacaine in Adductor Canal Block to Produce Quadriceps Weakness: A Dose-Finding Study.

Background And Objectives: Adductor canal block (ACB) is popular for knee analgesia because of its favorable effect on quadriceps strength. The aim of this study was to find the minimum volume of local anesthetic, which can be injected into the ACB that would result in quadriceps weakness.

Methods: This nonrandomized study used an up-and-down sequential allocation design.

Ultrasound-Guided Motor-Sparing Knee Blocks for Postoperative Analgesia Following Total Knee Arthroplasty: A Randomized Blinded Study.

Background: Pain following total knee arthroplasty (TKA) is often severe and can inhibit rehabilitation. Motor-sparing analgesic techniques such as periarticular infiltrations and adductor canal blocks have been popularized for knee analgesia since they preserve motor strength and permit early mobilization. Our primary objective was to compare the duration of analgesia from motor-sparing blocks with that of a standard periarticular infiltration.

Single-Injection Versus Multiple-Injection Technique of Ultrasound-Guided Paravertebral Blocks: A Randomized Controlled Study Comparing Dermatomal Spread.

Background And Objectives: The objective of this study was to investigate the extent of dermatomal spread following an ultrasound-guided thoracic paravertebral block (PVB) when equal volumes of local anesthetic are injected at 1 versus 5 vertebral levels.

Methods: Seventy patients undergoing a unilateral mastectomy were randomized to receive either single or multiple injections of a PVB under real-time ultrasound guidance using a parasagittal approach. The patients in the single-injection group received a PVB at T3-T4 level with 25 mL of 0.

Hybrid Blocks for Total Knee Arthroplasty: A Technical Description.

Introduction: This narrative review article aims to examine current evidence of knee innervation in order to develop a technique of targeting pure sensory innervation of the knee joint without compromising motor function.

Methods: A literature review of knee innervation was performed to gain an anatomic understanding of terminal sensory branches of the relevant target nerves (femoral, obturator, sciatic, and lateral femoral cutaneous).

Results: Pure sensory block of the knee joint is challenging due to important contributions from themuscular innervation close to the joint and the variability of nerves afferents contained within and around the adductor canal.

Temporary Decompression of Symptomatic Epidural Hematoma via an In Situ Epidural Catheter: A Case Report.

Spinal epidural hematoma (SEH) following neuraxial anesthesia needs prompt recognition and early decompressive measures to prevent long-term neurologic injury. We report a case of SEH presenting on the second postoperative day during an ongoing epidural infusion. Aspiration of blood through the epidural catheter and a subsequent improvement in the neurological symptoms made us suspect SEH, which was further confirmed by an MRI study.

A Comparison of Combined Suprascapular and Axillary Nerve Blocks to Interscalene Nerve Block for Analgesia in Arthroscopic Shoulder Surgery: An Equivalence Study.

Background And Objectives: The primary objective of this study was to compare the analgesic efficacy of combined suprascapular and axillary nerve block (SSAX) with interscalene block (ISB) after arthroscopic shoulder surgery. Our hypothesis was that ultrasound-guided SSAX would provide postoperative analgesia equivalent to ISB.

Methods: Sixty adult patients undergoing arthroscopic shoulder surgery received either SSAX or ISB prior to general anesthesia, in a randomized fashion.

Comparison of efficacy and safety of lateral-to-medial continuous transversus abdominis plane block with thoracic epidural analgesia in patients undergoing abdominal surgery: A randomised, open-label feasibility study.

Background: We recently described a lateral-to-medial approach for transversus abdominis plane (LM-TAP) block, which may permit preoperative initiation of the block.

Objective: Our objective was to evaluate the feasibility of continuous LM-TAP blocks in clinical practice in comparison with thoracic epidural analgesia (TEA).

Design: A randomised, open-label study.

ANATOMICAL VARIATIONS OF THE GREATER PALATINE NERVE IN THE GREATER PALATINE CANAL.

The greater palatine nerve and the greater palatine canal are common sites for maxillary anesthesia during dental and maxillo-facial procedures. The greater palatine nerve is thought to course as a single trunk through the greater palatine canal, branching after its exit from the greater palatine foramen. We describe intra-canalicular branching variations of the greater palatine nerve found in 8 of 20 embalmed dissection specimens.

Detection and visualization of dural pulsation for spine needle interventions.

Purpose: Epidural and spinal anesthesia are common procedures that require a needle to be inserted into the patient's spine to deliver an anesthetic. Traditionally, these procedures were performed without image guidance, using only palpation to identify the correct vertebral interspace. More recently, ultrasound has seen widespread use in guiding spinal needle interventions.

Effect of beam steering on the visibility of echogenic and non-echogenic needles: a laboratory study.

Purpose: During peripheral nerve block procedures, needle visibility decreases as the angle of needle insertion relative to skin increases due to loss of reflective signals. The primary aim of our study was to compare the effect of beam steering on the visibility of echogenic and non-echogenic block needles.

Methods: PAJUNK non-echogenic and echogenic needles were inserted into pork meat at 20°, 40°, 60°, and 70° angles, and electronic beam steering was applied at three different angles (shallow, medium, and steep) to obtain the best possible needle images.

Ultrasound-guided greater palatine nerve block: a case series of anatomical descriptions and clinical evaluations.

Background: Greater palatine nerve (GPN) block is commonly performed for maxillary and palatal anesthesia by using bony landmarks. Ultrasound (US) can be used to consistently identify greater palatine foramen (GPF) as a defect in the bony palate enabling US-guided injections near the foramen.

Methods: We scanned and injected 16 undissected well-embalmed hemisectioned cadaveric heads after excluding major anatomical malformations.

Feasibility of real-time workflow segmentation for tracked needle interventions.

Computer-assisted training systems promote both training efficacy and patient health. An important component for providing automatic feedback in computer-assisted training systems is workflow segmentation: the determination of what task in the workflow is being performed. Our objective was to develop a workflow segmentation algorithm for needle interventions using needle tracking data.

Navigated simulator for spinal needle interventions.

We present a navigated simulator for ultrasound-guided spine needle interventions, comprising of an ultrasound scanner, tracking system, surgical instruments, tissue-mimicking spine phantom, and augmented virtuality navigation platform. The ultrasound transducer, spine needle, and spine phantom are magnetically tracked and spatially calibrated, allowing the navigation software to render the surgical scene with streaming ultrasound video in 3D. The spine phantom provides sonoanatomically correct images, with realistic tactile sensation from needle advancement through tissues layers.

Pain and inflammatory response following off-pump coronary artery bypass grafting.

Purpose Of Review: Inflammation and pain are two common clinical issues following cardiac surgery, which are important to patient outcomes. This article reviews the literature regarding inflammation and pain following cardiac surgery with special emphasis on off-pump cardiac surgery.

Recent Findings: Off-pump surgery is associated with decreased intraoperative inflammatory response compared with procedures using cardiopulmonary bypass; however, the postoperative pattern of inflammatory response is similar to on-pump procedures.

Comparison of anatomic landmarks and ultrasound guidance for intercostal nerve injections in cadavers.

Background And Objectives: Intercostal nerve (ICN) injections are routinely performed under anatomic landmark or fluoroscopic guidance for acute and chronic pain indications. Ultrasound (US) is being used increasingly to perform ICN injections, but there is lack of evidence to support categorically the benefits of US over conventional techniques. We compared guidance with US versus anatomic landmarks for accuracy and safety of ICN injections in cadavers in a 2-phase study that included evaluation of deposition of injected dye by dissection and spread of contrast on fluoroscopy.

Wound/intra-articular infiltration or peripheral nerve blocks for orthopedic joint surgery: efficacy and safety issues.

Purpose Of Review: Pain following arthroplasty is managed utilizing continuous peripheral nerve blocks (PNB) or local infiltration analgesia (LIA). The current economic climate in many countries requires discharge from the hospital within a couple of days following arthroplasty. Earlier studies had documented the efficacy of LIA for lower limb arthroplasty with preserved motor function and early rehabilitation, but some recent studies fail to confirm such a benefit.