Ultrasound-Guided Regional Anesthesia and Patient Safety

Neal, Joseph M.

doi:10.1097/aap.0000000000000295

Cited by 230 publications

(118 citation statements)

References 110 publications

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“…Ultrasound guidance reduces the likelihood of any LAST event, yet seizure and/or cardiac arrest still occur at an estimated rate of 0.26/1000 ultrasound-guided blocks. 43 …”

Section: Registriesmentioning

confidence: 99%

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

Neal

Barrington

Fettiplace

et al. 2018

Regional Anesthesia and Pain Medicine

Self Cite

335

185

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The American Society of Regional Anesthesia and Pain Medicine's Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging information, the advisory updates recommendations pertaining to prevention, recognition, and treatment of local anesthetic systemic toxicity. WHAT'S NEW IN THIS UPDATE?: This interim update summarizes recent scientific findings that have enhanced our understanding of the mechanisms that lead to lipid emulsion reversal of LAST, including rapid partitioning, direct inotropy, and post-conditioning. Since the previous practice advisory, epidemiological data have emerged that suggest a lower frequency of LAST as reported by single institutions and some registries, nevertheless a considerable number of events still occur within the general community. Contemporary case reports suggest a trend toward delayed presentation, which may mirror the increased use of ultrasound guidance (fewer intravascular injections), local infiltration techniques (slower systemic uptake), and continuous local anesthetic infusions. Small patient size and sarcopenia are additional factors that increase potential risk for LAST. An increasing number of reported events occur outside of the traditional hospital setting and involve non-anesthesiologists.

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“…Ultrasound guidance reduces the likelihood of any LAST event, yet seizure and/or cardiac arrest still occur at an estimated rate of 0.26/1000 ultrasound-guided blocks. 43 …”

Section: Registriesmentioning

confidence: 99%

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

Neal

Barrington

Fettiplace

et al. 2018

Regional Anesthesia and Pain Medicine

Self Cite

335

185

View full text Add to dashboard Cite

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“…In turn, this could (theoretically) decrease the incidence of PONS 276. However, quality assurance and registry studies have found no difference in the prevalence of PONS between US and other localization techniques 270 276 291.…”

Section: Complications Of Lower Extremity Nerve Blocksmentioning

confidence: 99%

Lower extremity regional anesthesia: essentials of our current understanding

Tran

Salinas

Benzon

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

140

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The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine’s ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.

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“…5,6 The incidence of seizures due to intravenous local anaesthetic injection varies between 1 per 800 and 1 per 1500 when nerve stimulation is used. 7,8 Peripheral neurological complications not involving haematoma or infection are rare, 9 with the incidence of permanent nerve injury being approximately 2 per 10 000 axillary brachial plexus blocks performed with nerve stimulation, reported in the last survey of the SOS French Regional Anaesthesia Hotline. 10 blocks, the number of patients required to compare ultrasound guidance with nerve stimulation is prohibitively large.…”

Section: Introductionmentioning

confidence: 99%