Ultrasound-Guided Central Neuraxial Blocks

White Cane Approach to Teaching Spinal Anesthesia

“…Continued unsuccessful attempts to reach the subarachnoid space may be harmful and associated with complications, such as bleeding, nerve injury, and pain. Anesthesia textbooks, journal articles, 4–7 and videos 8 (see Supplemental Digital Content, Video, http://links.lww.com/AACR/A474) provide valuable recommendations and guidelines for various approaches to spinal anesthesia. It is important that trainees and instructors are familiar with these recommendations and know how to troubleshoot spinal anesthesia and alter their approach when the needle repeatedly encounters osseous structures, or they are unable to access the intrathecal space.…”

“…The alterations include choosing another interspace, avoiding the midline by using a paramedian or Taylor’s approach, 9 changing the patient’s position, using a larger single stiffer spinal needle without an introducer in older patients who are unlikely to experience postdural puncture headache, 10 using a model (Figure 6) to illustrate to the trainee the possible reasons for failure, and if skilled using ultrasonography. 11 See the Table for a discussion of these alterations.…”

Neuraxial analgesia, nerve blocks, and special considerations for the parturient

“…Skin markings can be made in the horizontal plane for an optimal insertion point. Reproduced from Karmakar et al 13 AC indicates anterior complex; ES, epidural space; ESM, erector spinae muscle; ITS, intrathecal space; PD, posterior dura; VB, vertebral body.…”

“…This view is most important for sagittal scanning to identify interlaminar spaces and mark the skin accordingly in the vertical plane. Reproduced from Karmakar et al 13 AC indicates complex; CE, cauda equina; ES, epidural space; ESM, erector spinae muscle; ILS, interlaminar space; ITS, intrathecal space; IVD, intervertebral disc; L3, lamina of L3 vertebra; L4, lamina of L4 vertebra; L5, lamina of L5 vertebra; LF, ligamentum flavum; PD, posterior dura.…”

Estudo Das Variações Anatômicas Do Nervo Isquiático E Sua Relação Com O Músculo Pirifome Em Universidades Públicas Do Estado Do Amazonas

“…Esta na administração de corticóides para diminuição e/ou eliminação de dores, anestesias peridurais, posicionamento de cateteres e até mesmo cirurgias minimamente invasivas como meio de entrada alternativa transmuscular para abordagens endoscópicas (KARMAKAR, 2009). O hiato sacral é uma abertura ampla que surge pela ausência de fusão das lâminas de S5 na linha mediana posterior, aproximadamente 5 cm acima da extremidade distal do sacro (MOORE, 2014).…”