The Experts below are selected from a list of 459 Experts worldwide ranked by ideXlab platform
Kenneth B. Chapman - One of the best experts on this subject based on the ideXlab platform.
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a paramedian approach for dorsal root ganglion stimulation placement developed to limit lead migration and fracture
Pain Practice, 2021Co-Authors: Kenneth B. Chapman, Noud Van Helmond, Matthew A Spiegel, David M Dickerson, Bart Billet, Kiran Patel, Corey W Hunter, Ajay Antony, Timothy R DeerAbstract:Introduction Dorsal root ganglion stimulation (DRG-S), has demonstrated superiority in the treatment of complex regional pain syndrome and causalgia. Lead migration and fracture impact DRG-S therapeutic stability. Lead anchoring reduces DRG-S lead migration without increasing lead fracture. Lead fracture may be related to lead entrapment in the superficial fascial plane. A novel medialized approach for lead placement and anchoring is presented to address these issues. Methods We suggest an alternative technique for implanting percutaneous DRG-S leads at the T10-L5 levels. Results A novel medialized ipsilateral technique for lead placement and anchoring for single, bilateral, and adjacent segment placement is presented. The Tuohy Needle puncture site is medial to the pedicle and adjacent to the spinous process, two vertebral levels caudad to the target foramen. Trajectory is maintained in the sagittal plane, to access the caudad interlaminar space near the midline. This technique allows for ipsilateral or contralateral lead placement. After epidural access, the introducer sheath is rotated toward the targeted foramen and advanced. The guidewire followed by the lead is passed, and once lead position is confirmed, tension 'S' loops are created, followed by anchoring to the deep fascia. Conclusion We describe a new paramedian technique for DRG-S lead placement. We propose it will decrease DRG-S complication rates through anchoring to reduce migration and by avoiding the fascial planes thought to be responsible for fracture. Long-term outcomes applying our proposed techniques are required for determining the true impact, however, early anecdotal results suggest that these new techniques are favorable.
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Dorsal Root Ganglion Stimulation Lead Fracture Within the Superficial Fascial Layers in 4 Cases.
A&A practice, 2020Co-Authors: Kenneth B. Chapman, Kiran V. Patel, Noud Van Helmond, George C. Chang ChienAbstract:We present 4 cases of dorsal root ganglion stimulation lead fracture. In these cases, the surgical technique involved (1) traversing fascial layers for placement of leads via a Tuohy Needle in the upper low back, (2) subcutaneous tunneling from the implantable pulse generator site to the lead puncture site without dissecting below the superficial fascial plane at the puncture site, and (3) connection of the lead/extension with the generator. All fractures occurred adjacent to the original lead puncture site. These cases suggest lead entrapment within the membranous fascial plane, with tension on a thin lead, is a mechanism underlying lead fracture.
A Casati - One of the best experts on this subject based on the ideXlab platform.
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a prospective randomized evaluation of the effects of epidural Needle rotation on the distribution of epidural block
Anesthesia & Analgesia, 2004Co-Authors: Battista Borghi, Vanni Agnoletti, Alessandro Ricci, Hanna Van Oven, Nicoletta Montone, A CasatiAbstract:We evaluated the effects of turning the tip of the Tuohy Needle 45° toward the operative side before threading the epidural catheter (45°-rotation group, n = 24) as compared to a conventional insertion technique with the tip of the Tuohy Needle oriented at 90° cephalad (control group, n = 24) on the
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a clinical comparison between Needle through Needle and double segment techniques for combined spinal and epidural anesthesia
Regional Anesthesia and Pain Medicine, 1998Co-Authors: A Casati, A Dambrosio, P De Negri, G Fanelli, V Tagariello, F TarantinoAbstract:Background and Objectives The goal of the present investigation was to compare the double-segment and the Needle-through-Needle techniques for combined spinal and epidural anesthesia (CSE) in a prospective, randomized, blinded study. Methods With Ethical Committee approval and patient9s consent, 120 patients were randomized to receive CSE by the Needle-through-Needle (SST; n = 60) or the double-segment technique (DST; n = 60). A blind observer measured the time required from skin disinfection to readiness for surgery (loss of pinprick sensation up to T10), failure of dural puncture, need for epidural top-up before surgery, patient acceptance, and occurrence of complications. Results No neurologic complications were observed in either group. Time to readiness for surgery was 22.7 ± 8.2 minutes in the SST group and 29.8 ± 8.31 minutes in the DST one (P Conclusions The Needle-through-Needle technique for CSE requires less time, has no greater failure rate, and results in greater patient satisfaction than the double-segment technique. The use of a spinal Needle with an adjustable locking mechanism and protruding up to 15 mm beyond the Tuohy Needle improved successful spinal block in the Needle-through-Needle technique compared with previous reports.
Sugantha Ganapathy - One of the best experts on this subject based on the ideXlab platform.
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injectate spread following ultrasound guided lateral to medial approach for dual transversus abdominis plane blocks
Acta Anaesthesiologica Scandinavica, 2015Co-Authors: Rakesh V Sondekoppam, Jonathan Brookes, L Morris, Marjorie Johnson, Sugantha GanapathyAbstract:Background Bilateral dual transversus abdominis plane (BD-TAP) injections were devised to cover the T7–8 and L1 dermatomes, which are usually spared with classical and mid-axillary TAP injections. The purpose of this study was to delineate the vertical and lateral extent of injectate spread following a lateral to medial approach for TAP injections in embalmed cadavers. Methods Ultrasound-guided subcostal and lateral TAP injections were performed on nine embalmed cadavers using 30 ml of 0.5% methylcellulose (20 ml for subcostal and 10 ml for lateral injections) with a 12-cm Tuohy Needle in the first six cadavers (nine hemi-abdomens). Vertical extent and the medial to lateral extent of the dye spread were recorded after dissections of the abdominal wall. In a pilot of three cadavers not receiving TAP injections, anatomical impediments to proximal injectate spread were explored separately. Results The vertical spread of injectate was T7–L1 (n = 2/9), T8–L1 (n = 5/9) and T9–L1 (n = 2/9). None of the TAP injections extended beyond the mid-axillary line. No anatomical impediments for the flow of injectate to the T7 or T8 intercostal nerves were found at the level of the interdigitations of the transversus abdominis muscle and diaphragm. Conclusion A lateral to medial approach for TAP injection resulted in spread of the injectate ranging from T7/8–L1 dermatomes in the majority of the hemi-abdomens. Subcostal and lateral TAP injections do not cover the lateral cutaneous branches of the segmental nerves.
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cervical epidural analgesia via a thoracic approach using nerve stimulation guidance in adult patients undergoing total shoulder replacement surgery
Acta Anaesthesiologica Scandinavica, 2007Co-Authors: Ban C H Tsui, J Bury, M Bouliane, Sugantha GanapathyAbstract:Background: Continuous cervical epidural anesthesia can provide excellent peri- and post-operative analgesia, although several factors prevent its widespread use. Advancing catheters from thoracic levels to the cervical region may circumvent these barriers, provided they are accurately positioned. We hypothesize that guiding catheters from thoracic to cervical regions using low-current epidural stimulation will have a high success rate and enable excellent analgesia in adults undergoing total shoulder arthroplasty. Methods: After Institutional Review Board approval, adult patients were studied consecutively. A 17-G Tuohy Needle was inserted into the thoracic epidural space using a right paramedian approach with loss of resistance. A 20-G styletted epidural catheter, with an attached nerve stimulator, was primed with saline and a 1–10 mA current was applied as it advanced in a cephalad direction towards the cervical spine. Muscle twitch responses were observed and post-operative X-ray confirmed final placement. After a test dose, an infusion (2–8 ml/h) of ropivacaine 2 mg/ml and morphine 0.05 mg/ml (or equivalent) was initiated. Verbal analog pain scale scores were collected over 72 h. Results: Cervical epidural anesthesia was performed on 10 patients. Average current required to elicit a motor response was 4.8 ± 2.0mA. Post-operative X-ray of catheter positions confirmed all catheter tips reached the desired region (C4–7). The technical success rate for catheter placement was 100% and excellent pain control was achieved. Catheters were positioned two to the left, four to the right and four to the midline. Conclusion: This epidural technique provided highly effective post-operative analgesia in a patient group that traditionally experiences severe post-operative pain and can benefit from early mobilization.
Timothy R Deer - One of the best experts on this subject based on the ideXlab platform.
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a paramedian approach for dorsal root ganglion stimulation placement developed to limit lead migration and fracture
Pain Practice, 2021Co-Authors: Kenneth B. Chapman, Noud Van Helmond, Matthew A Spiegel, David M Dickerson, Bart Billet, Kiran Patel, Corey W Hunter, Ajay Antony, Timothy R DeerAbstract:Introduction Dorsal root ganglion stimulation (DRG-S), has demonstrated superiority in the treatment of complex regional pain syndrome and causalgia. Lead migration and fracture impact DRG-S therapeutic stability. Lead anchoring reduces DRG-S lead migration without increasing lead fracture. Lead fracture may be related to lead entrapment in the superficial fascial plane. A novel medialized approach for lead placement and anchoring is presented to address these issues. Methods We suggest an alternative technique for implanting percutaneous DRG-S leads at the T10-L5 levels. Results A novel medialized ipsilateral technique for lead placement and anchoring for single, bilateral, and adjacent segment placement is presented. The Tuohy Needle puncture site is medial to the pedicle and adjacent to the spinous process, two vertebral levels caudad to the target foramen. Trajectory is maintained in the sagittal plane, to access the caudad interlaminar space near the midline. This technique allows for ipsilateral or contralateral lead placement. After epidural access, the introducer sheath is rotated toward the targeted foramen and advanced. The guidewire followed by the lead is passed, and once lead position is confirmed, tension 'S' loops are created, followed by anchoring to the deep fascia. Conclusion We describe a new paramedian technique for DRG-S lead placement. We propose it will decrease DRG-S complication rates through anchoring to reduce migration and by avoiding the fascial planes thought to be responsible for fracture. Long-term outcomes applying our proposed techniques are required for determining the true impact, however, early anecdotal results suggest that these new techniques are favorable.
David M Dickerson - One of the best experts on this subject based on the ideXlab platform.
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a paramedian approach for dorsal root ganglion stimulation placement developed to limit lead migration and fracture
Pain Practice, 2021Co-Authors: Kenneth B. Chapman, Noud Van Helmond, Matthew A Spiegel, David M Dickerson, Bart Billet, Kiran Patel, Corey W Hunter, Ajay Antony, Timothy R DeerAbstract:Introduction Dorsal root ganglion stimulation (DRG-S), has demonstrated superiority in the treatment of complex regional pain syndrome and causalgia. Lead migration and fracture impact DRG-S therapeutic stability. Lead anchoring reduces DRG-S lead migration without increasing lead fracture. Lead fracture may be related to lead entrapment in the superficial fascial plane. A novel medialized approach for lead placement and anchoring is presented to address these issues. Methods We suggest an alternative technique for implanting percutaneous DRG-S leads at the T10-L5 levels. Results A novel medialized ipsilateral technique for lead placement and anchoring for single, bilateral, and adjacent segment placement is presented. The Tuohy Needle puncture site is medial to the pedicle and adjacent to the spinous process, two vertebral levels caudad to the target foramen. Trajectory is maintained in the sagittal plane, to access the caudad interlaminar space near the midline. This technique allows for ipsilateral or contralateral lead placement. After epidural access, the introducer sheath is rotated toward the targeted foramen and advanced. The guidewire followed by the lead is passed, and once lead position is confirmed, tension 'S' loops are created, followed by anchoring to the deep fascia. Conclusion We describe a new paramedian technique for DRG-S lead placement. We propose it will decrease DRG-S complication rates through anchoring to reduce migration and by avoiding the fascial planes thought to be responsible for fracture. Long-term outcomes applying our proposed techniques are required for determining the true impact, however, early anecdotal results suggest that these new techniques are favorable.
