Dural puncture during lumbar epidural access in the setting of degenerative spondylolisthesis: case series and risk mitigation strategies.

Degenerative spondylolisthesis is a common back pathology in the general adult population. Patients with this condition may present for epidural steroid injection, epidural blood patch, or epidural analgesia. We report five patients with degenerative spondylolisthesis who experienced inadvertent dural puncture during interlaminar epidural steroid injection attempts: four with intrathecal contrast spread or cerebrospinal backflow into the epidural needle and one with subdural contrast spread.

Impact of Predefined Angles and a Revised APPLES Mnemonic on Accuracy and Performance Time for Simulated Ultrasound-Guided Injections.

Objectives: Our objective was to determine whether predefined angles would improve performance time and accuracy of ultrasound-guided procedures by novice operators and whether a revised APPLES (approach, position, perpendicular, lift, entry, sweep) mnemonic was a helpful guide for performing the procedure.

Methods: Participants attempted to hit targets in-plane and out-of-plane at different depths with a needle under ultrasound guidance with and without predefined angles. Participants were then asked if they thought that the mnemonic would be helpful when learning both methods for ultrasound-guided procedures.

Interventional treatments for metastatic bone cancer pain.

Metastatic bone cancer pain may cause significant morbidity among the cancer patient population. Painful bone lesions are challenging to manage due to the aggressive pathophysiology of the pain generator involved. The WHO's approach to cancer pain treatment involves the use of a three-step ladder which provides a guideline for clinicians to treat patients who struggle from cancer pain syndromes.

Improving the Performance Time and Accuracy of Ultrasound-Guided Interventions: A Randomized Controlled Double-Blind Trial of the Line-of-Sight Approach and the "APPLES" Mnemonic.

Objectives: To determine whether the line-of-sight approach improved the performance time and accuracy of ultrasound (US)-guided needle placement targeting the subdeltoid bursa in a cadaver among novice operators compared to the side approach. A secondary objective was to determine whether participants thought the APPLES (angle, position, perpendicular, line up, entry, sweep) mnemonic was a helpful guide for performing the procedure.

Methods: Medical students and residents were randomized into either a line-of-sight or side approach group and then crossed over to the other group.