Thin Sharp Needles Around the Dura

Boezaart, André P.; Franco, Carlo D.

doi:10.1016/j.rapm.2006.05.004

Cited by 11 publications

(3 citation statements)

References 6 publications

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“…Deviation of the tip of a flexible needle due to bending is a well‐known risk [20]. To minimise this risk, a large bore blunt needle should be considered when deeper peripheral nerve blocks are performed [21]. When using ultrasound regularly, one often notices that a stimulating needle can be placed in contact with a nerve without provoking muscle contractions.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided training in the performance of brachial plexus block by the posterior approach: an observational study

et al. 2007

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SummaryThe application of ultrasonography in guiding and controlling the path of the stimulating needle to the brachial plexus via the posterior approach (Pippa technique) was studied. In 21 ASA physical status 1 and 2 patients, scheduled for surgery of the shoulder or upper arm, needle insertion was monitored by ultrasonography and the interaction between needle, surrounding structures and brachial plexus was followed. During injection, the spread of local anaesthetic was visualised and a prediction of block success was made. One failure was predicted. Complete block was achieved in 20 (95%) patients. One potential complication, puncture of the carotid artery, was prevented using ultrasound. Ultrasound is a useful tool in the training and performance of a neurostimulation-guided brachial plexus block by the posterior approach. Ultrasonographic guidance may prevent serious complications associated with this approach to the brachial plexus.

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Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided training in the performance of brachial plexus block by the posterior approach: an observational study

et al. 2007

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“…[28] All the time-tested safety practices for spinal epidural injections should therefore similarly apply for root level or paraneuraxial or paraspinal extra- or epidural injections. These should include the use of large bore relatively blunt Tuohy needles and the avoidance of sharp thin needles (for continuous and single-injection blocks)[28]; the use of similar test doses to test for intravascular or intrathecal injection, fractionation of the main dose, and perhaps even similar guidelines for anticoagulation, although this is open to debate and can be expected to be further contested. [29] All the catastrophic, potentially catastrophic, and tragic cases, ranging from total spinal block to quadriplegia, referred to in the papers by Antonakakis et al .…”

Section: Microanatomymentioning

confidence: 99%

New trends in regional anesthesia for shoulder surgery: Avoiding devastating complications

Boezaart¹,

Tighe²

2010

Int J Shoulder Surg

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Surgeons and patients are often reluctant to support regional anesthesia (RA) for shoulder and other orthopedic surgeries. This is because of the sometimes true but usually incorrectly perceived “slowing down” of operating room turnover time and the perceived potential for added morbidity. Recently, severe devastating and permanent nerve injury complications have surfaced, and this article attempts to clarify the modern place of RA for shoulder surgery and the prevention of these complications. A philosophical approach to anesthesiology and regional anesthesiology is offered, while a fresh appreciation for the well-described and often forgotten microanatomy of the brachial plexus is revisited to explain and avoid some of the devastating complications of RA for shoulder surgery.

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“…18 All the time-tested safety practices for spinal epidural injections should therefore similarly apply for root-level or paraneuraxial epidural injections. These, in my opinion, should include the use of large-bore, relatively blunt Tuohy needles; the avoidance of sharp, thin needles (for continuous and single-injection blocksYyes, including interscalene blocks 19 ); the use of test doses for intravascular or intrathecal injection; fractionation of the main dose; and perhaps even similar guidelines for anticoagulation, 8 although this is open to debate and can be expected to be further contested.…”

Section: And Antonakakis Et Al 2 Bothmentioning

confidence: 99%

That Which We Call a Rose by Any Other Name Would Smell as Sweet-and Its Thorns Would Hurt as Much

Boezaart

2009

Regional Anesthesia and Pain Medicine

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Thin Sharp Needles Around the Dura

Cited by 11 publications

References 6 publications

Ultrasound‐guided training in the performance of brachial plexus block by the posterior approach: an observational study

Ultrasound‐guided training in the performance of brachial plexus block by the posterior approach: an observational study

New trends in regional anesthesia for shoulder surgery: Avoiding devastating complications

That Which We Call a Rose by Any Other Name Would Smell as Sweet-and Its Thorns Would Hurt as Much

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