Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2006
Randomized Controlled Trial Comparative StudyThe posterior approach to the sciatic nerve in the popliteal fossa: a comparison of single- versus double-injection technique.
We compared single-injection and double-injection of the sciatic nerve with nerve stimulation in the posterior popliteal approach using mepivacaine 1% in a prospective, randomized and single-blind study to evaluate effectiveness, delay of onset, and complications in patients undergoing foot and ankle surgery. In the single-injection group (Group S, n = 30), 25 mL of mepivacaine 1% was administered after eliciting foot inversion or plantar flexion. In the double-injection group (Group D, n = 30), 12.5 mL of the solution was injected after eversion or dorsiflexion and 12.5 mL after plantar flexion of the foot. ⋯ Complete analgesia of the deep peroneal nerve was achieved in 80% and 97% in Group S and D, respectively; P < 0.05. There were more paresthesias during block procedure in Group D (17% vs 40%) (P < 0.05). We conclude that double-nerve stimulation of the sciatic nerve gives similar complete onset times and overall success rate to single-nerve stimulation and more paresthesias during block performance.
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Anesthesia and analgesia · Dec 2006
Randomized Controlled TrialContinuous femoral nerve analgesia after unilateral total knee arthroplasty: stimulating versus nonstimulating catheters.
Continuous femoral analgesia provides extended pain relief and improved functional recovery for total knee arthroplasty (TKA). Stimulating catheters may allow more accurate placement of catheters. ⋯ The use of stimulating catheters in continuous femoral nerve blocks for TKA does not offer significant benefits over traditional nonstimulating catheters.
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Anesthesia and analgesia · Dec 2006
Randomized Controlled TrialSmall-dose ketamine reduces the pain of propofol injection.
I.v. injection of propofol during anesthetic induction induces pain. Ketamine has been shown to reduce injection pain. In this study, we established the optimal dose of ketamine to prevent the pain of injection with propofol. ⋯ Administration of ketamine 100 microg/kg immediately before propofol injection provided the optimal dose and timing to reduce propofol-induced pain on injection.
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Anesthesia and analgesia · Dec 2006
Outpatient management of continuous peripheral nerve catheters placed using ultrasound guidance: an experience in 620 patients.
Continuous peripheral nerve block (CPNB) is an optimal choice for analgesia after orthopedic procedures, but is not commonly used in outpatients because of concern regarding the possibility of catheter-related complications. In addition, it may be difficult to provide adequate patient access to physicians in this setting. We present 620 outpatients who were treated with CPNB using an established protocol. ⋯ In this large series of outpatients treated with CPNB, there were surprisingly few interventions requiring an anesthesiologist. Likewise, patients were able to manage and remove their catheters at home without additional follow-up. This suggests that with adequate instruction and telephone access to health care providers, patients are comfortable with managing and removing CPNB catheters at home.