ABSTRACT
Fused real-time ultrasound and magnetic resonance imaging (MRI) may be used to improve the accuracy of advanced image guided procedures. However, its use in regional anesthesia is practically nonexistent. In this randomized controlled crossover trial, we aim to explore effectiveness, procedure-related outcomes, injectate spread analyzed by MRI, and safety of ultrasound/MRI fusion versus ultrasound guided Suprasacral Parallel Shift (SSPS) technique for lumbosacral plexus blockade. Twenty-six healthy subjects aged 21-36 years received two SSPS blocks (20 mL 2% lidocaine-epinephrine [1 : 200,000] added 1 mL diluted contrast) guided by ultrasound/MRI fusion versus ultrasound. Number (proportion) of subjects with motor blockade of the femoral and obturator nerves and the lumbosacral trunk was equal (ultrasound/MRI, 23/26 [88%]; ultrasound, 23/26 [88%]; p = 1.00). Median (interquartile range) preparation and procedure times (s) were longer for the ultrasound/MRI fusion guided technique (686 [552-1023] versus 196 [167-228], p < 0.001 and 333 [254-439] versus 216 [176-294], p = 0.001). Both techniques produced perineural spread and corresponding sensory analgesia from L2 to S1. Epidural spread and lidocaine pharmacokinetics were similar. Different compartmentalized patterns of injectate spread were observed. Ultrasound/MRI fusion guided SSPS was equally effective and safe but required prolonged time, compared to ultrasound guided SSPS. This trial is registered with EudraCT (2013-004013-41) and ClinicalTrials.gov (NCT02593370).
Subject(s)
Anesthetics, Local , Lumbosacral Plexus/drug effects , Magnetic Resonance Imaging , Ultrasonography, Interventional/methods , Adult , Brachial Plexus Block/methods , Epidural Space/drug effects , Epinephrine/administration & dosage , Female , Humans , Lidocaine/administration & dosage , Lumbosacral Plexus/physiopathology , Male , Nerve Block/methodsABSTRACT
INTRODUCTION: A formalized trauma response team is designed to optimize the quality and progress of patient care for severely injured patients in order to reduce mortality and morbidity. The goal of this study was to determine over- and undertriage and to evaluate if a physician-manned pre-hospital response (MD-EMS) would reduce overtriage. Overtriage was defined as the process of over-estimating the level of injury sustained by an individual. MATERIAL AND METHODS: This was a retrospective study. All patients admitted with trauma team activation (TTA) (n = 1,468) during a four-year period (2007-2011) were included. Undertriage was estimated by assessing the fraction of major trauma patients (New Injury Severity Score (NISS) > 15) admitted to Viborg Regional Hospital in the project period without TTA. RESULTS: For each year, overtriage was 88.3% (2007), 89.9% (2008), 92.8% (2009) and 88.2% (2010); an NISS > 15 was seen in a total of 149 patients. Undertriage was 0.39% (2007), 0.46% (2008), 0.51% (2009) and 1.10% (2010); an NISS > 15 was seen in a total of 21 patients who were not received by a trauma team. We observed no significant difference in the NISS (p = 0.19) or in over-/undertriage (p = 0.76 and p = 0.058) when comparing the years before with the years after the introduction of the MD-EMS response. CONCLUSION: Our study shows a high degree of overtriage and a very low undertriage according to the currently accepted protocol guidelines. No effect was seen after the introduction of the MD-EMS. FUNDING: not relevant. TRIAL REGISTRATION: In compliance with the Scientific Committees for the Region of Central Jutland, approval for our project was obtained prior to collecting data.
Subject(s)
Anesthesiology , Emergency Medical Services/organization & administration , Patient Care Team/organization & administration , Triage/organization & administration , Triage/statistics & numerical data , Adult , Female , Humans , Male , Practice Guidelines as Topic , Retrospective Studies , Trauma Severity Indices , Triage/standards , Wounds and Injuries/classificationABSTRACT
In Denmark, early rehabilitation of acquired head injuries is centralised in two centres, each covering half the country as uptake area. The Regional Hospital Hammel Neurocenter (HN), which covers the western half of Denmark, traditionally receives patients for rehabilitation after discharge from the intensive care unit (ICU). In collaboration with the Regional Hospital in Silkeborg HN now offers early rehabilitation in Silkeborg's ICU setting to patients with acquired brain injury. This preliminary study discusses whether the collaboration facilitates rehabilitation at an earlier state than previously.
