Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2006
Randomized Controlled Trial Comparative StudyPostoperative analgesia after major spine surgery: patient-controlled epidural analgesia versus patient-controlled intravenous analgesia.
Spinal fusion surgery causes severe postoperative pain, hampering reconvalescense. We investigated the efficacy of patient-controlled epidural analgesia (PCEA) in a prospective, double-blind, randomized, controlled comparison with patient-controlled IV analgesia (PCIA). ⋯ We conclude that PCEA with ropivacaine and sufentanil, using intraoperatively placed epidural catheters, provides superior analgesia and higher patient satisfaction when compared with PCIA after spinal fusion surgery.
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Anesthesia and analgesia · Nov 2006
Randomized Controlled Trial Comparative StudyA single preoperative dose of gabapentin (800 milligrams) does not augment postoperative analgesia in patients given interscalene brachial plexus blocks for arthroscopic shoulder surgery.
Inadequate analgesia is common after shoulder arthroscopy. Both interscalene blocks and gabapentin are effective methods of pain management under various circumstances. We tested the hypothesis that gabapentin augments postoperative analgesia provided by interscalene brachial plexus block in patients having ambulatory arthroscopic shoulder surgery. ⋯ A single preoperative dose of gabapentin (800 mg) does not augment postoperative analgesia in patients given interscalene brachial plexus blocks for arthroscopic shoulder surgery.
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Anesthesia and analgesia · Nov 2006
Randomized Controlled Trial Comparative StudyThe analgesic efficacy of celecoxib, pregabalin, and their combination for spinal fusion surgery.
As optimal pain relief after surgery is difficult to achieve with the use of just one drug, many pain experts advocate the use of two or more classes of medications so as to reduce the side effects from any one drug. In this trial, we assessed the analgesic efficacy of administering perioperative celecoxib, pregabalin, or both after spinal fusion surgery. ⋯ The perioperative administration of the combination of celecoxib and pregabalin improved analgesia and caused fewer side effects, than either analgesic drug alone after spinal fusion surgery.
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Anesthesia and analgesia · Nov 2006
Randomized Controlled Trial Comparative StudyEvaluation of a proximal block site and the use of nerve-stimulator-guided needle placement for posterior tibial nerve block.
Posterior tibial nerve (PTN) block has traditionally been performed in the para-medial malleolar area without nerve stimulator (NS) guidance. The PTN can also be blocked proximally (7 cm) above the medial malleolus in the subfascial plane between the flexor hallucis longus and flexor digitorum longus tendons. In this study we compared the frequency of successful PTN block at the traditional distal (D) site (2 cm above the medial malleolus) with and without NS guidance. We also compared block success and latency at the D site versus the proximal (P) block site. ⋯ NS-guided needle placement improves the success and decreases the latency to onset of complete PTN block at the D site. The P approach to PTN block may be a useful alternative to the traditional D site approach, particularly in patients with restricted access to the D site.
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Anesthesia and analgesia · Nov 2006
ReviewVagal nerve stimulation: overview and implications for anesthesiologists.
Vagal nerve stimulation is an important adjunctive therapy for medically refractory epilepsy and major depression. Additionally, it may prove effective in treating obesity, Alzheimer's disease, and some neuropsychiatic disorders. ⋯ In this review, we will focus on the indications for vagal nerve stimulation (both approved and experimental), proposed therapeutic mechanisms for vagal nerve stimulation, and potential perioperative complications during initial VNS placement. Anesthetic considerations during initial device placement, as well as anesthetic management issues for patients with a preexisting VNS, are reviewed.