Since most of my day is spent in vb.net, I don't have the luxury of a “top shelf” refactoring tool (although I am anxiously awaiting a public beta or trial of Refactor!).  Latley, though, I've found the yahoo branded x1 to fit the bill quite nicely. 

In the past few days, on a number of occasions, I've used it to help when making a few changes.  I have it set to index all of my code, so within seconds I can see everywhere a method is called, as well as quickly scan the context of each call in the preview window.  It may not help in the IDE, but I was able to quickly evaluate my options for changes, and then hit the code with a good plan of attack in no time.

Since all the SQL is in scripts in a database project, I can also search across all the scripts in the system as well.  Added bonus that doesn't come with those fancy integrated solutions  :)