Citations

Background and Objectives. Preoperative time spent with patients has been abbreviated with the advent of same-day admission requirements and outpatient surgery. This study was conducted to evaluate the effects that materials mailed to the home relating to anesthetic-focused patient education may have on preoperative patient anxiety. Methods. Patients scheduled for a total hip arthroplasty or for a total knee arthroplasty were screened via telephone for inclusion in a prospective, randomized study. Patients were asked about their access to a video cassette recorder/player (VCR) and their limitations regarding hearing or vision. Subjects were randomly assigned to either the intervention group and received two pamphlets and a video describing general and regional anesthesia or to the usual care group. All subjects were mailed a preoperative demographic questionnaire and a State Trait Anxiety Inventory (STAI), as developed by CD Spielberger (1). Questionnaires were completed at least 96 hours prior to admission and again preoperative on the day of surgery. Results. Of 236 patients screened, 26 had no access to a VCR, 6 were hearing or visually impaired, and 4 declined participation. Of 200 subjects randomized, 134 completed both sets of questionnaires and thus form the basis of this report. A statistically significant difference between the subjects who received the video and pamphlets and the usual care subjects was detected with respect to change in STAI-assessed anxiety from baseline to immediately prior to surgery (P = .035). The intervention subjects experienced a smaller mean increase in anxiety. Forty-nine percent of the usual care subjects expressed interest in having additional information. Conclusions. Increase in preoperative anxiety is diminished when additional anesthesia information in printed and video format is made available. Useful information can be provided to patients to view or read prior to surgery.

Background and Objectives: Peripheral nerve stimulation (PNS) is analgesic for some lower extremity neuropathic pain syndromes. PNS currently involves open surgical placement of electrode(s). Increasingly, ultrasound guidance is used for perioperative neural block. Minimally invasive placement of PNS electrodes for lower extremity targets using ultrasound guidance has not been reported. We hypothesized that ultrasound-guided placement of PNS electrodes was feasible. Methods: Four cadaver mid-thigh transected fresh frozen specimens were studied. Specimens were scanned utilizing a 14 to 7 MHz linear probe and electrodes were placed proximal to the tibial, peroneal, and sciatic nerves at various locations. Anatomical dissection was performed to check placement accuracy and evaluate for grossly visible neural injuries. Results: Acceptable locations for ultrasound-guided electrode placement were: (1) tibial nerve, approximately 8 to 14 cm superior to the medial malleolus above the tarsal tunnel, or at the upper popliteal fossa; (2) peroneal nerve, approximately 2 to 4 cm inferior to the lateral fibular head or at the upper popliteal fossa; (3) sciatic nerve immediately superior to the bifurcation (high popliteal area); and (4) lateral sural nerve at the lower popliteal fossa. No grossly visible neural injuries were seen. Electrode placements appeared to be in satisfactory locations for stimulation. Conclusions: Ultrasound imaging to facilitate peripheral nerve electrode placement is feasible. This new minimally invasive approach to lead placement requires further study to determine trial implantation criteria, optimal locations, anchoring techniques, and best clinical practice.

Background and Objectives: Peripheral nerve stimulation (PNS) may provide analgesia for neuropathic pain syndromes in that nerve distribution. PNS electrode placement using ultrasound (US) guidance for upper extremity pain syndromes has not been reported. Existing anchoring technology may allow permanent implantation without significant migration. Methods: Three cadaver midhumeral fresh frozen upper extremity specimens were studied. US scanning was performed, targeting electrode placement at the radial, ulnar, and median nerves. Leads were anchored in the superficial fascia. The targeted nerves were exposed by careful dissection. Visual inspection for gross nerve damage, and electrode proximity to the nerve was performed. After confirmation of adequate lead placement, 2 extremities were sutured and placed in a continuous passive motion (CPM) machine for 21 hours to simulate activity. Each electrode was assessed for migration. Results: Acceptable locations for US-guided electrode placement were: radial nerve approximately 10-14 cm superior to the lateral epicondyle; median nerve approximately 6 cm below the antecubital fossa; and ulnar nerve approximately 9 to 13 cm above the medial epicondyle. One electrode was placed at each site without difficulty. After careful exposure, visual inspection showed no gross nerve damage. Each electrode had at least 2 electrical contacts within 2 mm of the nerve sheath. At CPM termination, only the median nerve electrode on 1 cadaver extremity had migrated significantly. Conclusions: This new minimally invasive approach to lead placement requires further study to determine implantation criteria, optimal locations, anchoring techniques, and electrode design to define best clinical practice.