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1.
Swiss Med Wkly ; 151(33-34)2021 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-34448557

RESUMO

AIMS OF THE STUDY: The Swiss healthcare system is highly ranked, given its unrestricted access to specialised care and short waiting lists for surgery. However, the need for anaesthetic and surgical care is escalating owing to the increasing size and ageing of the Swiss population. In addition, to address the persistent and recurrent SARS-CoV-2 pandemic crisis, the speciality of anaesthesia is under tremendous pressure to maintain an effective workforce in order to address population needs. The current number, characteristics and future evolution of the physician anaesthesia workforce in Switzerland are currently unknown. The purpose of this study was to assess the size and professional and sociodemographic characteristics of the current anaesthesia workforce in Switzerland and to forecast its development up to 2034. METHODS: We performed a cross-sectional study using a 150-item questionnaire prepared by the National Anaesthesia Workforce Study Group (NAWOS). We included all physicians (trainees and certified) practising anaesthesia in Switzerland. We collected demographic and professional information, such as the current position, hospital characteristics, workload, number of shifts and future life plans. We built a computer-based Markov model with Monte Carlo simulations to project both supply and demand for physician anaesthesia provider positions. RESULTS: Of the 2661 distributed questionnaires, 1985 (74.2%) were completed and returned. We found that the average age of anaesthesiologists practising in Switzerland was 45.2 years, with 44.3% of them being women and 76.9% holding a Swiss specialist title. Only 59.6% of respondents worked full time. The forecasting model showed a steady increase in the number of anaesthesiologists retiring by 2034, with 27% of full-time equivalent jobs being lost in the next 8 years. Even if existing full-time equivalent training positions are all filled, a gradual deficit of anaesthesiologists is to be expected after 2022, and the deficit should culminate in 2034 with a deficit ratio of 0.87. CONCLUSIONS: Due to the upcoming high retirement rate of anaesthesiologists, Switzerland is likely to face a shortage of anaesthesiologists in the near future. To compensate for the shortage, the country will likely increase its reliance on medical staff trained abroad. Southern and eastern cantons of Switzerland are particularly at risk, given that they already heavily rely on foreign anaesthesia workforce. This reliance should be considered a national priority because anaesthesiologists are heavily involved in both the treatment of patients with respiratory complications of SARS-CoV2 infection and the care of surgical patients, the number of which is expected to rise steadily in upcoming years.


Assuntos
Anestesia , COVID-19 , Médicos , Estudos Transversais , Feminino , Humanos , RNA Viral , SARS-CoV-2 , Suíça , Recursos Humanos
2.
Praxis (Bern 1994) ; 110(10): 579-589, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34344186

RESUMO

Peripheral Regional Anaesthesia for Perioperative Analgesia Abstract. Peripheral regional anaesthesia is the actual gold standard of opioid-sparing perioperative analgesia and is mainly used for surgery of the shoulder, arm and leg. Well-trained anaesthesiologists are the prerequisite for the correct individual risk-benefit assessment and the performance of the nerve blocks using a combination of ultrasound guidance and peripheral nerve stimulation (dual guidance). The postoperative care of the patients requires trained staff.


Assuntos
Anestesia por Condução , Bloqueio Nervoso , Estimulação Elétrica Nervosa Transcutânea , Analgésicos Opioides , Humanos , Dor Pós-Operatória/prevenção & controle , Ultrassonografia
3.
J Shoulder Elbow Surg ; 30(2): e60-e68, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32540315

RESUMO

BACKGROUND: The rotator cuff (RC) and the deltoid muscle are 2 synergistic units that enable the functionally demanding movements of the shoulder. A number of biomechanical studies assume similar force contribution of the force couple (RC and deltoid) over the whole range of motion, whereas others propose position-dependent force distribution. There is a lack of in vivo data regarding the deltoid's contribution to shoulder flexion and abduction strength. This study aimed to create reliable in vivo data quantifying the deltoid's contribution to shoulder flexion and abduction strength throughout the range of motion. METHODS: Active range of motion and isometric muscle strength of shoulder abduction and flexion in 0°, 30°, 60°, 90°, and 120° of abduction/flexion as well as internal and external rotation in 0° and 90° of abduction were obtained in 12 healthy volunteers on the dominant arm before and after an ultrasound-guided isolated axillary nerve block. Needle electromyography was performed before and after the block to confirm deltoid paralysis. Radiographs of the shoulder and an ultrasonographic examination were used to exclude relevant shoulder pathologies. RESULTS: Active range of motion showed a minimal to moderate reduction to 94% and 88% of the preintervention value for abduction and flexion. Internal and external rotation amplitude was not impaired. The abduction strength was significantly reduced to 76% at 0° (P = .002) and to 25% at 120° (P < .001) of abduction. The flexion strength was significantly reduced to 64% at 30° (P < .001) and to 30% at 120° (P < .001) of flexion. The strength reduction was linear, depending on the flexion/abduction angle. The maximal external rotation strength showed a significant decrease to 53% in 90° (P < .001) of abduction, whereas in adduction no strength loss was observed (P = .09). The internal rotation strength remained unaffected in 0° and 90° of abduction (P = .28; P = .13). CONCLUSION: The deltoid shows a linear contribution to maximal shoulder strength depending on the abduction or flexion angle, ranging from 24% in 0° to 75% in 120° of abduction and from 11% in 0° to 70% in 120° of flexion, respectively. The overall contribution to abduction strength is higher than to flexion strength. The combination of deltoid muscle and teres minor contributes about 50% to external rotation strength in 90° of abduction. The internal rotation strength is not influenced by a deltoid paralysis. This study highlights the position-dependent contribution of the shoulder muscles to strength development and thereby provides an empirical approach to better understand human shoulder kinematics.


Assuntos
Articulação do Ombro , Ombro , Fenômenos Biomecânicos , Músculo Deltoide , Humanos , Amplitude de Movimento Articular , Rotação , Manguito Rotador , Articulação do Ombro/diagnóstico por imagem
4.
Eur J Anaesthesiol ; 37(9): 758-764, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32453168

RESUMO

BACKGROUND: Ultrasound has increased the efficacy of femoral nerve catheters but their postoperative dislocation still remains a common problem. Although catheter placement parallel to the nerve seems to reduce dislocation rates in other nerves and plexuses, the possible advantage for femoral nerve catheter placement remains unclear. OBJECTIVE: To compare the dislocation rates of femoral catheters when placed perpendicular or parallel to the femoral nerve. DESIGN: Randomised controlled study. SETTING: University orthopaedic hospital. Duration of study: October 2018 to June 2019. PATIENTS: Eighty patients scheduled for major knee surgery with femoral catheter were enrolled and randomly allocated in two groups. Data from 78 patients could be analysed. INTERVENTIONS: The femoral nerve catheters was placed perpendicular to the nerve in Group 1 (n=40), whereas in Group 2 (n=38) parallel to it. For Group 1 the short-axis view of the nerve and an in-plane puncture was used. For Group 2 we used the short-axis view of the nerve and an out-of-plane puncture technique combined with rotation of the transducer to the long-axis view with the needle in-plane. MAIN OUTCOME MEASURES: Primary outcome was the catheter dislocation rate in the first 48 h. Secondary outcomes were pain scores and sensory blockade. RESULTS: There was no statistically significant difference between the two techniques regarding dislocation of the catheters at 24 or 48 h (at 48 h, Group 1: 15%, Group 2: 2.6%, P = 0.109). Also pain scores, sensory blockade and rescue doses of ropivacaine did not differ between the groups. However, in Group 2 the technique took longer. CONCLUSION: Rotating the ultrasound probe to the long-axis in-plane view enabled examination of the catheter position when it was placed parallel to the nerve. The parallel placement of the catheter required more time, but did not significantly improve dislocation rate, pain scores or sensory blockade. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03693755.


Assuntos
Nervo Femoral , Bloqueio Nervoso , Anestésicos Locais , Cateteres , Nervo Femoral/diagnóstico por imagem , Humanos , Bloqueio Nervoso/efeitos adversos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Ropivacaina , Ultrassonografia de Intervenção
5.
Clin Anat ; 33(4): 488-499, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31050830

RESUMO

Combined ultrasound (US)-guided blockade of the suprascapular and axillary nerves (ANs) has been proposed as an alternative to interscalene blockade for pain control in shoulder joint pathology or postsurgical care. This technique could help avoid respiratory complications and/or almost total upper limb palsy. Nowadays, the AN blockade is mostly performed using an in-plane caudal-to-cephalic approach from the posterior surface of the shoulder, reaching the nerve immediately after it exits the neurovascular quadrangular space (part of the spatium axillare). Despite precluding most respiratory complications, this approach has not made postsurgical pain relief any better than an interscalene blockade, probably because articular branches of the AN are not blocked.Cephalic-to-caudal methylene blue injections were placed in the first segment of the AN of six Thiel-embalmed cadavers using an US-guided anterior approach in order to compare the distribution with that produced by a posterior approach to the contralateral AN in the same cadaver. Another 21 formalin-fixed cadavers were bilaterally dissected to identify the articular branches of the AN.We found a good spread of the dye on the AN and a constant relationship of this nerve with the subscapularis muscle. The dye reached the musculocutaneous nerve, which also contributes to shoulder joint innervation. We describe the anatomical landmarks for an ultrasonography-guided anterior AN blockade and hypothesize that this anterior approach will provide better pain control than the posterior approach owing to complete blocking of the joint nerve. Clin. Anat. 33:488-499, 2020. © 2019 Wiley Periodicals, Inc.


Assuntos
Bloqueio do Plexo Braquial/métodos , Plexo Braquial/anatomia & histologia , Articulação do Ombro/inervação , Articulação do Ombro/cirurgia , Ultrassonografia de Intervenção , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Sci Rep ; 9(1): 9178, 2019 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-31235760

RESUMO

Ultrasound has significantly increased safety and effectiveness in regional anesthesia. However, little is known about its clinical use. We studied clinical approaches currently used by anesthesiologists, conducted a nationwide survey, and analyzed data collected in ordered logistic regression models. All active members of the Swiss Society for Anaesthesiology and Resuscitation (SSAR/SGAR) were asked to participate. Reported practice in nerve localization, safety, and techniques used for peripheral nerve blocks (PNB) were main outcome measures. Experience ranged from 3 to >30 years. The mean number of block techniques mastered was 11.5 ± 5.9. Standard monitoring was regularly used, whereas sterile coats were less frequently used by anesthesiologists who self-estimated a higher level of expertise in PNB (ordered logit coefficient -0.05, 95% CI -0.07 to -0.02, P < 0.001; pseudo r2 = 0.019; probability > Chi2 = 0.02). The more self-estimated expertise anesthesiologists had, the less likely they were to use nerve stimulation in combination with ultrasound (dual guidance) (ordered logit coefficient -0.31; 95% CI -0.85 to -0.03: P = 0.03; pseudo r2 = 0.007; probability > Chi2 = 0.05). The high share of reported standard monitoring meets the recommendations of the Helsinki Patient Safety Declaration. Dual guidance appears to be the preferred approach for safely localizing nerves for PNB in Switzerland.


Assuntos
Anestesiologistas , Bloqueio Nervoso/métodos , Nervos Periféricos/diagnóstico por imagem , Anestésicos Locais/uso terapêutico , Feminino , Humanos , Masculino , Prática Profissional , Inquéritos e Questionários , Suíça , Ultrassonografia de Intervenção
7.
A A Pract ; 13(5): 176-180, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31045588

RESUMO

Shoulder surgery in the beach chair position is routinely performed, and central neurological events are rare but potentially devastating. We present a patient with transient neurological deficits after a sudden blood pressure drop with a simultaneous decrease of regional cerebral saturation values registered by cerebral oximetry. We reviewed published cases and proposed possible strategies to prevent the occurrence of similar complications in this context.


Assuntos
Ataque Isquêmico Transitório/diagnóstico , Monitorização Intraoperatória/métodos , Ombro/cirurgia , Idoso , Circulação Cerebrovascular , Feminino , Humanos , Ataque Isquêmico Transitório/sangue , Resultado do Tratamento
10.
Reg Anesth Pain Med ; 40(6): 713-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26414871

RESUMO

BACKGROUND AND OBJECTIVES: Medial branch blocks are frequently performed to diagnose lumbar facet-joint-mediated pain. Ultrasound guidance can increase practicability and eliminate exposure to ionizing radiation when compared with fluoroscopy. However, ultrasound-guided L5 dorsal ramus block, which, together with L4 medial branch block is necessary to anesthetize the most commonly affected facet joint L5/S1, has not been described so far. The objective of this study was to develop a technique and to evaluate its accuracy with standard fluoroscopy in unpreselected cadavers. METHODS: Twenty ultrasound-guided L5 dorsal ramus block approaches were performed with a new oblique out-of-plane technique in a rotated cross-axis view bilaterally in 10 cadavers. After checking the needle position in a second perpendicular sonographic plane, the final needle position was confirmed with conventional fluoroscopy by an independent observer. RESULTS: All cadavers had significant degenerations of the lumbar spine, and 5 of them had moderate to severe spondylolisthesis. Skin-to-target distances were 42 ±7 mm. Sixteen L5 dorsal ramus block attempts were located at the exact radiological target, 1 was slightly too lateral, and 3 were slightly too caudal (3-10 mm away). The overall success rate in unpreselected cadavers reached 80% (95% confidence interval, 56%-94%) and in the subgroup of corpses without spondylolisthesis 100% (95% confidence interval, 69%-100%). CONCLUSIONS: This is the first study to show that ultrasound-guided L5 dorsal ramus block is accurate and feasible in the absence of significant spondylolisthesis when performed with an oblique out-of-plane technique.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Bloqueio Nervoso/métodos , Nervos Espinhais/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade
11.
Vet Med Sci ; 1(2): 39-50, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29067173

RESUMO

The analgesic effects of peripheral nerve blocks can be prolonged with the placement of perineural catheters allowing repeated injections of local anaesthetics in humans. The objectives of this study were to evaluate the clinical suitability of a perineural coiled catheter (PCC) at the sciatic nerve and to evaluate pain during the early post-operative period in dogs after tibial plateau levelling osteotomy. Pre-operatively, a combined block of the sciatic and the femoral nerves was performed under sonographic guidance (ropivacaine 0.5%; 0.3 mL kg-1 per nerve). Thereafter, a PCC was placed near the sciatic nerve. Carprofen (4 mg kg-1 intravenously) was administered at the end of anaesthesia. After surgery, all dogs were randomly assigned to receive four injections of ropivacaine (group R; 0.25%, 0.3 mL kg-1) or NaCl 0.9% (group C; 0.3 mL kg-1) every 6 h through the PCC. Pain was assessed by use of a visual analogue scale (VAS) and a multi-dimensional pain score (4Avet) before surgery (T-1), for 390 min (T0, T30, T60, T120, T180, T240, T300, T360 and T390) as well as 1 day after surgery (Day 1). Methadone (0.1 mg kg-1) was administered each time the VAS was ≥40 mm or the 4Avet was ≥5. At T390 dogs received buprenorphine (0.02 mg kg-1). Data were compared using Mann-Whitney rank sum tests and repeated measures analysis of variance. Regardless of group allocation, 55% of dogs required methadone. VAS was significantly lower at T390 (P = 0.003), and at Day 1 (P = 0.002) and so was 4Avet at Day 1 (P = 0.012) in group R than in group C. Bleeding occurred in one dog at PCC placement and PCC dislodged six times of 47 PCCs placed. Minor complications occurred with PCC but allowed four repeated administrations of ropivacaine or saline over 24 h in 91.5% of the cases.

12.
Pain Physician ; 17(6): 507-13, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25415775

RESUMO

BACKGROUND: Approximately 6% to 8% of lumbar pain cases, whether associated with radicular pain or not, may be attributed to the presence of piriformis muscle syndrome. Available treatments, among others, include pharmacotherapy, physical therapy, and injections of different substances into the muscle. Various methods have been used to confirm correct needle placement during these procedures, including electromyography (EMG), fluoroscopy, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography (US) has now become a widely used technique and therefore may be an attractive alternative for needle guidance when injecting this muscle. OBJECTIVE: The objective of this study was to assess the reliability of US in piriformis injection of patients with piriformis syndrome. STUDY DESIGN: Feasibility study; 10 patients with piriformis muscle syndrome were injected with botulinum toxin A using a US-guided procedure. Then patients were administered 2 mL iodinated contrast and were then transferred to the CT scanner, where they underwent pelvic and hip imaging to assess intramuscular distribution of the iodinated contrast. SETTING: Multidisciplinary Pain Management Department in Spain. RESULTS: Of all 10 study patients (8 women, 2 men), 9 had intramuscular or intrafascial contrast distribution. Distribution did not go deeper than the piriformis muscle in any of the patients. The absence of contrast (intravascular injection) was not observed in any case. LIMITATIONS: The main limitation of our study is the use of ionizing radiation as confirmation technique. CONCLUSION: Ultrasound-guided puncture may be a reliable and simple procedure for injection of the piriformis muscle, as long as good education and training are provided to the operator. US has a number of advantages over traditional approaches, including accessibility and especially no ionizing radiation exposure for both health care providers and patients.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Meios de Contraste/farmacocinética , Fármacos Neuromusculares/administração & dosagem , Síndrome do Músculo Piriforme/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/normas , Adulto , Toxinas Botulínicas Tipo A/farmacologia , Meios de Contraste/administração & dosagem , Estudos de Viabilidade , Feminino , Humanos , Injeções Intramusculares/métodos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/farmacologia , Ultrassonografia/métodos
14.
Lab Anim ; 48(2): 97-104, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24464921

RESUMO

The sheep is a popular animal model for human biomechanical research involving invasive surgery on the hind limb. These painful procedures can only be ethically justified with the application of adequate analgesia protocols. Regional anaesthesia as an adjunct to general anaesthesia may markedly improve well-being of these experimental animals during the postoperative period due to a higher analgesic efficacy when compared with systemic drugs, and may therefore reduce stress and consequently the severity of such studies. As a first step 14 sheep cadavers were used to establish a new technique for the peripheral blockade of the sciatic and the femoral nerves under sonographic guidance and to evaluate the success rate by determination of the colorization of both nerves after an injection of 0.5 mL of a 0.1% methylene blue solution. First, both nerves were visualized sonographically. Then, methylene blue solution was injected and subsequently the length of colorization was measured by gross anatomical dissection of the target nerves. Twenty-four sciatic nerves were identified sonographically in 12 out of 13 cadavers. In one animal, the nerve could not be ascertained unequivocally and, consequently, nerve colorization failed. Twenty femoral nerves were located by ultrasound in 10 out of 13 cadavers. In three cadavers, signs of autolysis impeded the scan. This study provides a detailed anatomical description of the localization of the sciatic and the femoral nerves and presents an effective and safe yet simple and rapid technique for performing peripheral nerve blocks with a high success rate.


Assuntos
Nervo Femoral/cirurgia , Injeções Subcutâneas/métodos , Bloqueio Nervoso/métodos , Nervo Isquiático/cirurgia , Ultrassonografia de Intervenção , Animais , Cadáver , Corantes , Feminino , Nervo Femoral/diagnóstico por imagem , Azul de Metileno , Nervo Isquiático/diagnóstico por imagem , Ovinos
15.
Pain Med ; 14(5): 646-9, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23438374

RESUMO

OBJECTIVE: Injection of opioids to the superior cervical ganglion (SCG) has been reported to provide pain relief in patients suffering from different kinds of neuropathic facial pain conditions, such as trigeminal neuralgia, postherpetic neuralgia, and atypical facial pain. The classic approach to the SCG is a transoral technique using a so-called "stopper" to prevent accidental carotid artery puncture. The main disadvantage of this technique is that the needle tip is positioned distant from the actual target, possibly impeding successful block of the SCG. A further limitation is that injection of local anesthetics due to potential carotid artery puncture is contraindicated. We hypothesized that the SCG can be identified and blocked using ultrasound imaging, potentially increasing precision of this technique. INTERVENTIONS: In this pilot study, 20 US-guided simulated blocks of the SCG were performed in 10 human cadavers in order to determine the accuracy of this novel block technique. After injection of 0.1 mL of dye, the cadavers were dissected to evaluate the needle position and coloring of the SCG. RESULTS: Nineteen of the 20 needle tips were located in or next to the SCG. This corresponded to a simulated block success rate of 95% (95% confidence interval 85-100%). In 17 cases, the SCG was completely colored, and in two cases, the caudal half of the SCG was colored with dye. CONCLUSIONS: The anatomical dissections confirmed that our ultrasound-guided approach to the SCG is accurate. Ultrasound could become an attractive alternative to the "blind" transoral technique of SCG blocks.


Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/métodos , Gânglio Cervical Superior/efeitos dos fármacos , Gânglio Cervical Superior/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
16.
Reg Anesth Pain Med ; 37(6): 657-64, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23080347

RESUMO

The use of ultrasound in pain medicine for interventional axial, nonaxial, and musculoskeletal pain procedures is rapidly evolving and growing. Because of the lack of specialty-specific guidelines for ultrasonography in pain medicine, an international collaborative effort consisting of members of the Special Interest Group on Ultrasonography in Pain Medicine from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies developed the following recommendations for education and training in ultrasound-guided interventional pain procedures. The purpose of these recommendations is to define the required skills for performing ultrasound-guided pain procedures, the processes for appropriate education, and training and quality improvement. Training algorithms are outlined for practice- and fellowship-based pathways. The previously published American Society of Regional Anesthesia and Pain Medicine and European Society of Regional Anaesthesia and Pain Therapy education and teaching recommendations for ultrasound-guided regional anesthesia served as a foundation for the pain medicine recommendations. Although the decision to grant ultrasound privileges occurs at the institutional level, the committee recommends that the training guidelines outlined in this document serve as the foundation for educational training and the advancement of the practice of ultrasonography in pain medicine.


Assuntos
Anestesiologia/educação , Anestesiologia/normas , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção , Credenciamento , Bolsas de Estudo , Humanos , Bloqueio Nervoso/normas , Manejo da Dor , Melhoria de Qualidade
17.
Anesthesiology ; 117(2): 347-52, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22728783

RESUMO

BACKGROUND: Cervical zygapophysial joint nerve blocks typically are performed with fluoroscopic needle guidance. Descriptions of ultrasound-guided block of these nerves are available, but only one small study compared ultrasound with fluoroscopy, and only for the third occipital nerve. To evaluate the potential usefulness of ultrasound-guidance in clinical practice, studies that determine the accuracy of this technique using a validated control are essential. The aim of this study was to determine the accuracy of ultrasound-guided nerve blocks of the cervical zygapophysial joints using fluoroscopy as control. METHODS: Sixty volunteers were studied. Ultrasound-imaging was used to place the needle to the bony target of cervical zygapophysial joint nerve blocks. The levels of needle placement were determined randomly (three levels per volunteer). After ultrasound-guided needle placement and application of 0.2 ml contrast dye, fluoroscopic imaging was performed for later evaluation by a blinded pain physician and considered as gold standard. Raw agreement, chance-corrected agreement κ, and chance-independent agreement Φ between the ultrasound-guided placement and the assessment using fluoroscopy were calculated to quantify accuracy. RESULTS: One hundred eighty needles were placed in 60 volunteers. Raw agreement was 87% (95% CI 81-91%), κ was 0.74 (0.64-0.83), and Φ 0.99 (0.99-0.99). Accuracy varied significantly between the different cervical nerves: it was low for the C7 medial branch, whereas all other levels showed very good accuracy. CONCLUSIONS: Ultrasound-imaging is an accurate technique for performing cervical zygapophysial joint nerve blocks in volunteers, except for the medial branch blocks of C7.


Assuntos
Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/inervação , Adulto , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/inervação , Meios de Contraste/administração & dosagem , Feminino , Humanos , Masculino , Valores de Referência , Reprodutibilidade dos Testes , Ultrassonografia Doppler em Cores , Adulto Jovem , Articulação Zigapofisária/efeitos dos fármacos
18.
BJU Int ; 110(11): 1796-800, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22452577

RESUMO

UNLABELLED: Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Vasectomy reversal is often performed in general or neuraxial anaesthesia. Even though the site of vasectomy reversal is easily amenable to regional/local anaesthesia, spermatic cord blocks are rarely applied because of their risk of vascular damage within the spermatic cord. Recently, we described the technique of ultrasonography (US)-guided spermatic cord block for scrotal surgery, which, thanks to the US guidance, at the same time avoids the risk of vascular damage of blindly performed injections and the risks of general and neuraxial anaesthesia. Vasectomy reversal can easily be done in regional anaesthesia with the newly described technique of US-guided spermatic cord block without the risks of vascular damage by a blindly performed injection and the risks of standard general and neuraxial anaesthesia. In addition, this technique grants long-lasting postoperative pain relief and patients recover more quickly. Microsurgical conditions are excellent and patient satisfaction is high. Thanks to these advantages, more patients undergoing vasectomy reversal might avoid general or neuraxial anaesthesia. OBJECTIVE: • To assess the success rate, microsurgical conditions, postoperative recovery, complications and patient satisfaction of ultrasonography (US)-guided spermatic cord block in patients undergoing microscopic vasectomy reversal and to compare them to a control group with general or neuraxial anaesthesia. PATIENTS AND METHODS: • The present study comprised a prospective series of 10 consecutive patients undergoing US-guided spermatic cord block for microscopic vasectomy reversal. • The cohort was compared with 10 patients in a historical control group with general or neuraxial anaesthesia. RESULTS: • Nineteen of 20 (95%) blocks were successful, defined as no pain >3 on the Visual Analogue Scale (VAS), no additional analgesics and/or no conversion to general anaesthesia. Median pain was 0 on the VAS (range 0-5). Additional analgesics were requested in one (5%) block, and there was no conversion to general anaesthesia. • Microsurgical conditions were excellent. • In the spermatic cord block vs general/neuraxial anaesthesia groups, median times (range) between surgery and first postoperative analgesics, alimentation, mobilization and hospital discharge were 12 (2-14) vs 3 (1-6), 1 (0.25-3) vs 4 (3-6), 2 (1-3) vs 6 (3-10), and 4 (3-11) vs 8.5 (6-22) h, respectively. • No complications were reported after the spermatic cord block. • Patient satisfaction was excellent. CONCLUSIONS: • US-guided spermatic cord block for microscopic vasectomy reversal is highly successful and provides long-lasting perioperative analgesia. • Times to alimentation, mobilization and hospital discharge are shorter under US-guided spermatic cord block than under general/neuraxial anaesthesia. • Additional anaesthetic pain management might, however, be required unexpectedly with US-guided spermatic cord block.


Assuntos
Amidas , Anestésicos Locais , Mepivacaína , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Vasovasostomia/métodos , Adulto , Idoso , Estudos de Viabilidade , Humanos , Complicações Intraoperatórias/prevenção & controle , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Dor/prevenção & controle , Satisfação do Paciente , Estudos Prospectivos , Ropivacaina , Cordão Espermático/inervação
19.
Reg Anesth Pain Med ; 37(3): 325-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22222688

RESUMO

BACKGROUND AND OBJECTIVES: The suprascapular nerve (SSN) block is frequently performed for different shoulder pain conditions and for perioperative and postoperative pain control after shoulder surgery. Blind and image-guided techniques have been described, all of which target the nerve within the supraspinous fossa or at the suprascapular notch. This classic target point is not always ideal when ultrasound (US) is used because it is located deep under the muscles, and hence the nerve is not always visible. Blocking the nerve in the supraclavicular region, where it passes underneath the omohyoid muscle, could be an attractive alternative. METHODS: In the first step, 60 volunteers were scanned with US, both in the supraclavicular and the classic target area. The visibility of the SSN in both regions was compared. In the second step, 20 needles were placed into or immediately next to the SSN in the supraclavicular region of 10 cadavers. The accuracy of needle placement was determined by injection of dye and following dissection. RESULTS: In the supraclavicular region of volunteers, the nerve was identified in 81% of examinations (95% confidence interval [CI], 74%-88%) and located at a median depth of 8 mm (interquartile range, 6-9 mm). Near the suprascapular notch (supraspinous fossa), the nerve was unambiguously identified in 36% of examinations (95% CI, 28%-44%) (P < 0.001) and located at a median depth of 35 mm (interquartile range, 31-38 mm; P < 0.001). In the cadaver investigation, the rate of correct needle placement of the supraclavicular approach was 95% (95% CI, 86%-100%). CONCLUSIONS: Visualization of the SSN with US is better in the supraclavicular region as compared with the supraspinous fossa. The anatomic dissections confirmed that our novel supraclavicular SSN block technique is accurate.


Assuntos
Bloqueio Nervoso/métodos , Nervos Periféricos/diagnóstico por imagem , Ombro/inervação , Ultrassonografia de Intervenção , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Distribuição de Qui-Quadrado , Corantes/administração & dosagem , Feminino , Humanos , Verde de Indocianina/administração & dosagem , Injeções , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Posicionamento do Paciente , Nervos Periféricos/anatomia & histologia , Decúbito Dorsal , Suíça , Adulto Jovem
20.
Reg Anesth Pain Med ; 37(2): 224-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22157739

RESUMO

BACKGROUND AND OBJECTIVES: The most common techniques to perform stellate ganglion blocks (SGBs) are the blind C6 approach and the fluoroscopic-controlled paratracheal C7 approach, both after manual dislocation of the large vessels. Complications due to vascular or esophageal puncture have been reported. The goal of this ultrasound imaging study was to determine how frequently hazardous structures are located along the needle path of conventional SGB and to determine the influence of the dislocation maneuver on their position. METHODS: Sixty volunteers were examined on both sides. The presence of the esophagus, vertebral artery, and other arteries located within the needle path of an SGB at the C6 and C7 levels was determined before and during the dislocation maneuver. RESULTS: On the left side, the esophagus was located along the needle path in 22 and 39 of 60 cases at the C6 and C7 levels, respectively, and remained there in 10 and 22 of 60 cases during dislocation. The esophagus appeared in the needle path during dislocation from a previously safe location in 5 and 8 of these cases at the C6 and C7 locations, respectively. The vertebral artery was located in the needle path in a range of 2 to 8 of 60 cases without impact of dislocation on its position. Other arteries were located in the needle path in the range of 10 to 17 of 60 cases with a slight decrease during dislocation. CONCLUSIONS: The esophagus and relevant arteries were frequently located in the needle path of conventional SGBs. The dislocation maneuver had a partial impact on moving these structures away from the target and may increase left-sided esophageal puncture risk in certain individuals. Ultrasound (US) imaging is expected to improve the safety of SGB, but it will require clinical trials to confirm this expectation.


Assuntos
Bloqueio Nervoso Autônomo/efeitos adversos , Esôfago/diagnóstico por imagem , Punções , Gânglio Estrelado/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Artéria Vertebral/diagnóstico por imagem , Adulto , Bloqueio Nervoso Autônomo/métodos , Esôfago/lesões , Feminino , Humanos , Masculino , Artéria Vertebral/lesões , Adulto Jovem
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