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Ultrasound-Guided Continuous Peripheral Nerve Blocks

Introduction Ultrasound-guided continuous peripheral nerve blocks can be placed with high success rates and low complication profiles in both adults and children. Peripheral nerve catheters are more beneficial than traditional opioid-based analgesia and also are associated with improved pain control, lower opioid requirements, less nausea, and greater patient satisfaction when compared with single-shot blocks. Catheters are commonly placed at the interscalene, supraclavicular, infraclavicular, sciatic, femoral, adductor…

Approach and Techniques

Offline Markings Offline techniques involve external skin markings from ultrasound scans without imaging during needle placement. Changes in patient position, mobility of the skin, and dynamic changes with needle placement and injection limit the utility of this approach, but this approach can be used for neuraxial blocks. The skin adjacent to the sides of the transducer can be marked. Alternatively, a paper clip or solid metal…

Needle Imaging

Needle tip visibility is critical to the success and safety of regional block interventions. It is imperative to identify the needle tip before advancing the needle. The cut on the bevel is the best identifier of the needle tip for a beveled needle. Partial line-ups (so that the needle tip is not within the plane of imaging but some of the needle shaft is) are a…

Chuck North: A 32-Year-Old Veteran With Pain in the Ball of His Foot

Learning Objectives Learn the common causes of foot pain. Develop an understanding of the anatomy of the metatarsals. Develop an understanding of the causes of metatarsalgia. Develop an understanding of the differential diagnosis of foot pain. Learn the clinical presentation of metatarsalgia. Learn how to use physical examination to identify metatarsalgia. Develop an understanding of the treatment options for metatarsalgia. Chuck North Chuck North is a…

Betty Bartholomew : A 32-Year-Old Pharmacist With Persistent Foot Pain

Learning Objectives Learn the common causes of foot pain. Develop an understanding of the unique vascular anatomy of the sesamoid. Develop an understanding of the causes of sesamoiditis. Learn the clinical presentation of sesamoiditis. Learn how to use physical examination to identify pathology of the sesamoid. Develop an understanding of the treatment options for sesamoiditis. Learn the appropriate testing options to help diagnose sesamoiditis. Learn to…

Ada Hunt: A 31-Year-Old Customer Service Representative With Pain in the Arch of the Left Foot

Learning Objectives Learn the common causes of foot pain. Develop an understanding of the innervation of the groin and pelvis. Develop an understanding of the anatomy of the posterior tibial tendons. Develop an understanding of the causes of posterior tibial tendinitis. Learn the clinical presentation of posterior tibial tendinitis. Learn how to use physical examination to identify posterior tibial tendinitis. Develop an understanding of the treatment…