Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 1999
Multicenter Study Clinical TrialThe PENCAN 25-gauge needle: a new pencil-point needle for spinal anesthesia tested in 1,193 patients.
The PENCAN 25-gauge spinal needle is a new pencil-point needle with an inner diameter of 0.32 mm resulting in a relatively high cerebrospinal fluid (CSF) flow. The PENCAN 25-gauge needle was tested for ease of identification of a successful dural puncture, the failure rate of spinal anesthesia, and the incidence of postdural puncture headache (PDPH). ⋯ A failure rate of 1.9% together with a 1.3% incidence of PDPH were comparable to other 25-gauge pencil-point needles. The rapid appearance of CSF and a perceptible "click" made prompt recognition of successful dural puncture possible.
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Reg Anesth Pain Med · Jan 1999
A survey of exposure to regional anesthesia techniques in American anesthesia residency training programs.
The American Board of Anesthesiologists and the Residency Review Committee for Anesthesiology do not keep records regarding the individual resident's cumulative exposure to specific peripheral nerve block techniques. Further, little is known about individual trainee confidence in performing regional anesthetic blocks. To improve training and anesthesia practice, such information is necessary. In this nationwide survey, we assessed residents' perceived cumulative regional anesthesia experience and their confidence level. ⋯ Most CA-3 residents are confident in performing lumbar epidural and spinal anesthesia. However, many are not confident in performing the blocks with which they have the least exposure. Changes need to be made in the training processes so that residents can graduate with enough confidence to continue selecting less familiar blocks in postgraduate practice.
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Reg Anesth Pain Med · Jan 1999
ReviewNeuraxial techniques for cancer pain: an opinion about unresolved therapeutic dilemmas.
Epidural and intrathecal techniques are well established for minimizing cancer pain. However, several issues remain unresolved. ⋯ A subcutaneous tunnelling and fixation of the catheter, bacterial filters, minimum changes of tubings, weekly exit site care, site protection, and monitoring for any signs of infection are suggested for advanced cancer patients. Areas still needing clarification include the optimum use of spinal adjuvants, the appropriate spinal morphine-bupivacaine ratio, methods to improve spinal opioid responsiveness, and long-term catheter management during home-care programs.
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Reg Anesth Pain Med · Jan 1999
Clinical TrialThe incidence of transient radicular irritation after spinal anesthesia in obstetric patients.
Transient radicular irritation (TRI) has been described after spinal anesthesia, particularly with 5% hyperbaric spinal lidocaine. The purpose of this study was to determine the incidence of TRI in obstetric patients. ⋯ The incidence of TRI after spinal lidocaine anesthesia in the obstetric population is low.
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Reg Anesth Pain Med · Jan 1999
Randomized Controlled Trial Clinical TrialThe effects of arm position on central spread of local anesthetics and on quality of the block with axillary brachial plexus block.
Spread of local anesthetic solution in axillary brachial plexus block is thought to be influenced by the position of the arm and the use of compression maneuvers. We investigated how these two factors affected central local anesthetic spread and block quality. ⋯ The central spread of local anesthetics is facilitated by injection without abduction of the arm but not by the use of compression at the injection site. This, however, did not alter the quality of the block.