ABSTRACT
Ultrasound techniques and peripheral nerve stimulation have increased the interest in peripheral nerve injections for chronic pain. The knowledge of anatomy and nerve distribution patterns is paramount for optimal use of peripheral nerve blocks in the management of chronic pain conditions. They are an important tool in an interventional pain physician's armamentarium and can be integrated into pain practices effectively to offer patients pain relief.
Subject(s)
Chronic Pain , Nerve Block , Chronic Disease , Chronic Pain/drug therapy , Humans , Nerve Block/methods , Pain Management , Peripheral Nerves/diagnostic imagingABSTRACT
BACKGROUND: Correct identification of the epidural space minimizes complications and ensures successful epidural blockade. The loss of resistance technique is the most common technique used for identification of the epidural space. However, sometimes loss of resistance occurs when the needle is not actually in the epidural space. The injection in this instance will result in the medication not being deposited in the epidural space. At other times, loss of resistance is not definitive. Further advancement of the needle may predispose to a wet tap. METHODS: A simple manual technique was devised using pressure applied with two fingers (bi-digital pressure test; BiP Test). RESULTS: The technique helps distinguish true loss of resistance from a false loss of resistance. CONCLUSION: This technique adds a useful confirmatory test to the already well-known loss of resistance technique used to verify the position of the epidural needle.
Subject(s)
Epidural Space/surgery , Injections, Epidural/standards , Nerve Block/standards , Epidural Space/anatomy & histology , Epidural Space/physiology , Humans , Injections, Epidural/instrumentation , Injections, Epidural/methods , Lateral Ligament, Ankle/anatomy & histology , Lateral Ligament, Ankle/physiology , Lateral Ligament, Ankle/surgery , Monitoring, Physiologic/methods , Monitoring, Physiologic/standards , Needles/standards , Nerve Block/instrumentation , Nerve Block/methods , Pressure , Spinal Canal/anatomy & histology , Spinal Canal/physiology , Spinal Canal/surgery , Spine/anatomy & histology , Spine/physiology , Spine/surgerySubject(s)
Brachial Plexus , Nerve Block/instrumentation , Nerve Block/methods , Brachial Plexus/surgery , Humans , NeedlesABSTRACT
BACKGROUND: The interscalene brachial plexus block (ISBPB) is a most reliable and commonly performed technique for regional anesthesia of the upper extremity. It has widespread clinical applicability, ranging from use for shoulder surgery as well as diagnostic and therapeutic uses in pain management. Traditional methods described for performing the ISBPB involve identifying surface anatomy landmarks. Unfortunately, in patients with less than ideal landmarks (those with short, thick necks and those lacking adequate muscle tone in the neck area) it becomes increasingly challenging to identify these landmarks. As a result there is greater uncertainty in accurately locating the brachial plexus, and consequently greater risk in performing the block. METHODS: A simple new approach to the interscalene brachial plexus block is described, utilizing the bony anatomy of the cervical spine as a landmark for directing the needle to the correct position, a nerve stimulator, and a confirmatory injection of a test dose of anesthetic solution to enhance accuracy. In addition, by correctly implementing this technique, the block may be performed by a sole operator. RESULTS: This simple approach has proven to be clinically effective in more than 2,000 blocks of the brachial plexus during the past 4 years. CONCLUSION: It is concluded that this technique represents a safe, reproducible, and highly successful method for use by anesthesiologists and pain physicians alike.
