diaphragmatic-ultrasound-adults-image-acquisition

Diaphragmatic Ultrasound in Adults: Image Acquisition and Interpretation

Diaphragm dysfunction is a widely recognized concern across numerous medical specialties and clinical settings. Timely and accurate assessment of the ...

Duke University School of Medicine, Duke University Health System

Enhanced recovery after surgery (ERAS) programs for orthopedics involve a multidisciplinary approach to accelerating return to function, reducing pain, improving patient comfort and satisfaction, reducing complications from the surgical procedure, reducing hospital length of stay, and reducing costs. ERAS pathways for patients receiving total knee arthroplasty are different from those having intracavitary surgery; they are less focused on fluid homeostasis and gut motility than they are with optimizing systemic and local analgesics and providing a balance between the highest quality pain control and accelerated return to ambulation.

Updates in Enhanced Recovery Pathways for Total Knee Arthroplasty.

Targeted intracluster supraclavicular brachial plexus block: too close for comfort.

Nerve injury is a relatively rare but devastating complication of peripheral nerve blockade (PNB). Monitoring injection pressure during PNB is one method advocated to prevent injury by detecting needle tip placement in a noncompliant position (intraneural or abutting the epineurium). Animal studies show that gross neural damage and clinical injury are associated with injection pressures exceeding 15-20 psi. In contrast, pressures <15 psi are associated with an extraneural needle tip position and no histologic or clinical injury. Injection pressure monitoring has been shown to prevent injection against the brachial plexus roots or femoral nerve during peripheral nerve block. Multiple methods are available to monitor injection pressure, and most of them are inexpensive and easy to use. Large-scale registry database or pragmatic trials are indicated to show that injection pressure monitoring reduces injury in a patient setting.

Pressure monitoring: The evidence so far.

The erector spinae plane block: the case of the elusive mechanism of action.

Local anesthetic blockade of the genicular nerves, known targets of radiofrequency ablative techniques for knee pain, has not previously been studied in a randomized controlled trial evaluating acute pain after knee arthroplasty. We hypothesized that genicular nerve blockade added to an existing block regimen in total knee arthroplasty would result in a reduction in 24 hours opioid consumption.

Ultrasound-guided genicular nerve blocks following total knee arthroplasty: a randomized, double-blind, placebo-controlled trial.

Erector spinae plane (ESP) blocks can be used to provide analgesia following thoracoabdominal and lumbar spine surgical procedures. However, the influence of injectate volume and injection location on the spread of anesthetic with ESP blocks remain unclear.

Relationship between injectate volume and disposition in erector spinae plane block: a cadaveric study.

To investigate the efficacy, safety, pharmacodynamics, and pharmacokinetics of liposomal bupivacaine (LB) administered via ultrasound-guided sciatic nerve block in the popliteal fossa in participants undergoing bunionectomy.

Article	Year
Updates in Enhanced Recovery Pathways for Total Knee Arthroplasty. Anesthesiology clinics\| PubMed ID: 30092935	2018
Targeted intracluster supraclavicular brachial plexus block: too close for comfort. British journal of anaesthesia\| PubMed ID: 30929761	2019
Pressure monitoring: The evidence so far. Best practice & research. Clinical anaesthesiology\| PubMed ID: 31272653	2019
The erector spinae plane block: the case of the elusive mechanism of action. Canadian journal of anaesthesia = Journal canadien d'anesthesie\| PubMed ID: 33403541	2021
Ultrasound-guided genicular nerve blocks following total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Regional anesthesia and pain medicine\| PubMed ID: 34261807	2021
Relationship between injectate volume and disposition in erector spinae plane block: a cadaveric study. Regional anesthesia and pain medicine\| PubMed ID: 37758461	2024
A phase 3 active-controlled trial of liposomal bupivacaine via sciatic nerve block in the popliteal fossa after bunionectomy. Journal of clinical anesthesia\| PubMed ID: 38340677	2024

Jeff Gadsden

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