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Epidural injection

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https://www.readbyqxmd.com/read/28809679/automatic-localization-of-the-needle-target-for-ultrasound-guided-epidural-injections
#1
Mehran Pesteie, Victoria Lessoway, Purang Abolmaesumi, Robert N Rohling
Accurate identification of the needle target is crucial for effective epidural anesthesia. Currently, epidural needle placement is administered by a manual technique, relying on the sense of feel, which has a significant failure rate. Moreover, misleading the needle may lead to inadequate anesthesia, post dural puncture headaches and other potential complications. Ultrasound offers guidance to the physician for identification of the needle target, but accurate interpretation and localization remain challenges...
August 11, 2017: IEEE Transactions on Medical Imaging
https://www.readbyqxmd.com/read/28807894/advances-in-the-diagnosis-and-management-of-neck-pain
#2
REVIEW
Steven P Cohen, W Michael Hooten
Neck pain imposes a considerable personal and socioeconomic burden-it is one of the top five chronic pain conditions in terms of prevalence and years lost to disability-yet it receives a fraction of the research funding given to low back pain. Although most acute episodes resolve spontaneously, more than a third of affected people still have low grade symptoms or recurrences more than one year later, with genetics and psychosocial factors being risk factors for persistence. Nearly half of people with chronic neck pain have mixed neuropathic-nociceptive symptoms or predominantly neuropathic symptoms...
August 14, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28801567/effectiveness-of-a-multimodal-pain-management-concept-for-patients-with-cervical-radiculopathy-with-focus-on-cervical-epidural-injections
#3
Achim Benditz, Melanie Brunner, Florian Zeman, Felix Greimel, Völlner Florian, Daniel Boluki, Joachim Grifka, Markus Weber, Tobias Renkawitz
Cervical radiculopathy has become an increasing problem worldwide. Conservative treatment options have been recommended in many reviews on cervical radiculopathy, ranging from different types of physiotherapy to waiting for remission by natural history. No multimodal pain management concept (MPM) on an inpatient basis has been evaluated. This study aimed at showing the positive short-term effects of an inpatient multimodal pain management concept with focus on cervical translaminar epidural steroid injection for patients with cervical radiculopathy...
August 11, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28799128/the-influence-of-epidural-catheter-on-the-incidence-of-intravascular-injection-during-caudal-block
#4
Jin Young Lee, Sung Hyun Lee, Woo Seog Sim, Duk Kyung Kim, Sang Hoon Lee, Hyo Min Yun, Hue Jung Park
OBJECTIVE: The aim of this study was to analyze the influence of epidural catheters on the incidence of intravascular injection and to identify possible predictors of intravascular injection in patients undergoing a caudal block using fluoroscopy. METHODS: A total of 154 patients scheduled to receive a caudal block were randomized into group N (those without epidural catheter) or group C (those with epidural catheter). Demographic and clinical data were recorded and analyzed...
August 10, 2017: Skeletal Radiology
https://www.readbyqxmd.com/read/28797646/spinal-epidural-abscess-a-series-of-101-cases
#5
Martin Vakili, Nancy F Crum-Cianflone
BACKGROUND: Spinal epidural abscesses are uncommon but potentially devastating infections that often elude early diagnosis. An increasing incidence has been suggested; however, few contemporary data are available regarding risk factors and epidemiologic trends over time. METHODS: A retrospective study of spinal epidural abscesses from 2004 to 2014 at a large academic hospital was conducted. Cases were identified using ICD-9 code 324.1, and a review of medical and radiographic records was performed to confirm each case...
August 7, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28796547/do-superior-or-inferior-interlaminar-approach-or-bevel-orientation-predispose-to-nonepidural-needle-penetration
#6
Nicholas A Koontz, Richard H Wiggins, Gregory J Stoddard, Lubdha M Shah
OBJECTIVE: There is a paucity of evidence-based literature regarding the advantages and disadvantages of the interlaminar approach and needle bevel orientation for performing a lumbar interlaminar epidural steroid injection (ESI). The purpose of this study was to determine if superior versus inferior lamina approach, needle bevel tip orientation, or both may predispose to inadvertent nonepidural penetration during lumbar interlaminar ESI. SUBJECTS AND METHODS: A prospective study was performed of patients with low back pain with or without radicular pain or neurogenic claudication referred for lumbar interlaminar ESI...
August 10, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28796131/beyond-ultrasound-guidance-for-regional-anesthesiology
#7
De Q Tran, André P Boezaart, Joseph M Neal
Despite its popularity, ultrasound (US)-guided regional anesthesiology is associated with significant limitations. The latter can be attributed to either the US machine (ie, decreased ability to insonate deep neural structures, as well as the thoracic spine) or the operator. Shortcomings associated with the operator can be explained by errors in perception (ie, ambiguous criteria for needle/catheter tip-to-nerve proximity and subparaneural local anesthetic injection) or interpretation. Perhaps the greatest confusion afflicting US-guided regional anesthesiology originates from an intellectual misconception pertaining to its application...
September 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28790007/targeted-epidural-blood-patch-under-o-arm-guided-stereotactic-navigation-in-patients-with-intracranial-hypotension-associated-with-a-spinal-csf-leak-and-ventral-dural-defect
#8
Keisuke Takai, Makoto Taniguchi
OBJECTIVE: Targeted epidural blood patch (EBP) at the site of a presumed cerebrospinal fluid leak reportedly has better outcomes than non-targeted EBP; however, it is associated with a higher risk of wrong-site injection such as iatrogenic subarachnoid or intramuscular injections, which lead to reintervention due to the insufficient coverage of injected blood. METHODS: Eight patients with intracranial hypotension due to a CSF leak diagnosed by myelographic CT and thin-cut MRI received an epidural blood patch under O-arm-guided stereotactic navigation...
August 5, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28759948/the-role-of-epidural-contrast-distribution-in-predicting-the-effectiveness-of-steroid-and-local-anesthetic-injection-in-patients-with-lumbar-spinal-stenosis
#9
Jong Won Kwon, Sang Jun Kim
STUDY DESIGN: A prospective observational comparative study. BACKGROUND: Because epidural corticosteroids are more effective for pain relief when delivered close to the site of pathology, lumbar spinal stenosis with multilevel stenotic areas can be treated more effectively when medications cover all of the stenotic areas. Distribution of medications to the pathologic sites is considered an important factor in the effectiveness of inter-laminar epidural injection...
July 14, 2017: Journal of Back and Musculoskeletal Rehabilitation
https://www.readbyqxmd.com/read/28758078/contrast-spread-in-the-superoposterior-approach-of-transforaminal-epidural-steroid-injections-for-lumbosacral-radiculopathy
#10
Young Cheol Jeong, Chung Ho Lee, Seok Kang, Joon Shik Yoon
OBJECTIVE: To observe the contrast spread in superoposterior transforaminal epidural steroid injection (SP TFESI) and investigate the correlation between spread patterns and efficacy. METHODS: Thirty-one patients with lumbosacral radiculopathy underwent single-level TFESI under fluoroscopy. The final needle tip position was targeted toward the SP quadrant of the intervertebral foramen. To observe the spread, 1 mL of contrast material was injected, followed by a steroid injection...
June 2017: Annals of Rehabilitation Medicine
https://www.readbyqxmd.com/read/28757923/comparison-of-clinical-efficacy-in-epidural-steroid-injections-through-transforaminal-or-parasagittal-approaches
#11
Ji Hee Hong, Eun Kyul Park, Ki Bum Park, Ji Hoon Park, Sung Won Jung
BACKGROUND: The transforaminal (TF) epidural steroid injection (ESI) is suggested as more effective than the interlaminar (IL) route due to higher delivery of medication at the anterior epidural space. However, serious complications such as spinal cord injury and permanent neural injury have been reported. The purpose of this study is to evaluate and compare the clinical effectiveness, technical ease, and safety of the TF and parasagittal IL (PIL) ESI. METHODS: A total of 72 patients were randomized to either the PIL group (n = 41) or the TF group (n = 31) under fluoroscopic guidance...
July 2017: Korean Journal of Pain
https://www.readbyqxmd.com/read/28757831/cervical-epidural-puncture-guided-by-fluoroscopy-in-comparison-to-acoustic-signals-clinical-results
#12
Ali Hm, Ymr Toble, Yya Tolba
BACKGROUND AND AIM: The increasing cases of the cervical epidural but the practitioners in need for a new method to decrease the safety of the injection and to improve the learning curve of the trainee. Furthermore, it should replace the potentially hazards, conventional one, which is the fluoroscope. Acoustic signals were tested for this purpose. METHODS: Thirty-two patients were assigned to have a cervical epidural for pain management using both acoustic signals and fluoroscopy simultaneously...
July 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28742241/cervical-epidural-injection-in-management-of-refractory-pain-and-stiffness-in-spondyloarthropathy-a-case-report-series
#13
Semih Gungor, Rohit Aiyer, Doruk Erkan
In this case report series, we present the management of three patients with cervical epidural steroid injection, who presented with neck pain and stiffness secondary to spondyloarthropathy refractory to conservative management. This article is protected by copyright. All rights reserved.
July 25, 2017: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/28741272/an-up-down-determination-of-the-required-seated-duration-after-intrathecal-injection-of-bupivacaine-and-fentanyl-for-the-prevention-of-hypotension-during-cesarean-delivery
#14
Albert Moore, Eva El-Mouallem, Aly El-Bahrawy, Ian Kaufman, Mahmoud Moustafa, Simone Derzi, Roupen Hatzakorzian, William Lipishan
PURPOSE: A prolonged seated time after intrathecal injection of hyperbaric bupivacaine and morphine is related to the incidence of hypotension during Cesarean delivery, but results in a high incidence of pain during peritoneal closure. We conducted this study to determine the effect of the addition of intrathecal fentanyl on the relationship between seated time and hypotension and intraoperative analgesia requirements. METHODS: Women undergoing Cesarean delivery were randomized to receive an intrathecal injection of either 11...
July 24, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28740682/combined-analgesic-treatment-of-epidural-and-paravertebral-block-after-thoracic-surgery
#15
Yujiro Yokoyama, Takahiro Nakagomi, Daichi Shikata, Taichiro Goto
In pulmonary surgical practice, appropriate pain management after thoracotomy is essential for patient recovery and the prevention of complications. Although epidural analgesia (EPI) has been established for chest surgery, it has some limitations and contraindications. Recently, paravertebral block (PVB) was reported as a good alternative method with fewer side effects. Despite the significant effects of these two treatments, postoperative pain remains among the greatest patient burdens. In our institution, we apply a combination of epidural and PVBs after thoracic surgery to reduce pain more effectively...
June 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28729296/analysis-of-30-spinal-angiograms-falsely-reported-as-normal-in-18-patients-with-subsequently-documented-spinal-vascular-malformations
#16
P Barreras, D Heck, B Greenberg, J-P Wolinsky, C A Pardo, P Gailloud
BACKGROUND AND PURPOSE: The early diagnosis of spinal vascular malformations suffers from the nonspecificity of their clinical and radiologic presentations. Spinal angiography requires a methodical approach to offer a high diagnostic yield. The prospect of false-negative studies is particularly distressing when addressing conditions with a narrow therapeutic window. The purpose of this study was to identify factors leading to missed findings or inadequate studies in patients with spinal vascular malformations...
July 20, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28728944/ultrasound-guided-thoracic-paravertebral-block-cadaveric-study-in-foxes-vulpes-vulpes
#17
Paolo Monticelli, Ian Jones, Jaime Viscasillas
OBJECTIVE: To describe an ultrasound-guided thoracic paravertebral block in canidae. STUDY DESIGN: Prospective, experimental, cadaveric study. ANIMALS: Twelve thawed fox cadavers. METHODS: A 15 MHz linear transducer was used to visualize the paravertebral space at the level of the fifth thoracic vertebrae. Iohexol (300 mg mL(-1)) at 0.2 mL kg(-1) was injected into the right and left paravertebral spaces under ultrasound guidance using a Tuohy needle...
March 22, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28727702/subcutaneous-injection-of-triamcinolone-and-lidocaine-to-prevent-postherpetic-neuralgia
#18
Jiaxiang Ni, Xiaoping Wang, Yuanzhang Tang, Liqiang Yang, Yuanjie Zeng, Yuna Guo
BACKGROUND: Herpes zoster (HZ) is associated with inflammation of the peripheral nerves, which is considered to be an important cause of postherpetic neuralgia (PHN). Interventions aimed at reducing this inflammation could prevent PHN. One option is the epidural administration of corticosteroid and local anesthetic. However, several authors have reported a risk of arachnoiditis with epidural corticosteroids. Subcutaneous injection in an outpatient setting is a safer option. However, there is limited evidence of the effectiveness of this alternative for preventing PHN...
July 2017: Pain Physician
https://www.readbyqxmd.com/read/28727597/bilateral-continuous-erector-spinae-plane-block-contributes-to-effective-postoperative-analgesia-after-major-open-abdominal-surgery-a-case-report
#19
Carlos Eduardo Restrepo-Garces, Ki Jinn Chin, Patricia Suarez, Alejandro Diaz
The erector spinae plane (ESP) block is a regional anesthetic technique involving local anesthetic injection in a paraspinal plane deep to the erector spinae muscle. Originally described for thoracic analgesia when performed at the T5 transverse process, the ESP block can provide abdominal analgesia if performed at lower thoracic levels because the erector spinae muscles extend to the lumbar spine. A catheter inserted into this plane can extend analgesic duration and can be an alternative to epidural analgesia...
July 19, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28727314/transperitoneal-rectus-sheath-block-and-transversus-abdominis-plane-block-for-laparoscopic-inguinal-hernia-repair-a-novel-approach
#20
Jun Nagata, Jun Watanabe, Masato Nagata, Yusuke Sawatsubashi, Masaki Akiyama, Takehide Tajima, Koichi Arase, Noritaka Minagawa, Takayuki Torigoe, Yoshifumi Nakayama, Reiko Horishita, Kentaro Kida, Kotaro Hamada, Keiji Hirata
INTRODUCTION: A laparoscopic approach for inguinal hernia repair is now considered the gold standard. Laparoscopic surgery is associated with a significant reduction in postoperative pain. Epidural analgesia cannot be used in patients with perioperative anticoagulant therapy because of complications such as epidural hematoma. As such, regional anesthetic techniques, such as ultrasound-guided rectus sheath block and transversus abdominis plane block, have become increasingly popular. However, even these anesthetic techniques have potential complications, such as rectus sheath hematoma, if vessels are damaged...
August 2017: Asian Journal of Endoscopic Surgery
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