Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 1999
Randomized Controlled Trial Comparative Study Clinical TrialPreoperative intra-articular morphine and bupivacaine for pain control after outpatient arthroscopic anterior cruciate ligament reconstruction.
The purpose of this study was to determine whether intra-articular injection of bupivacaine, morphine, or a combination prior to surgery provided pain control after arthroscopic anterior cruciate ligament (ACL) reconstruction. ⋯ Presurgical injection of a solution of 0.25 % bupivacaine, morphine, and epinephrine provided pain control and decreased opioid use in the PACU. Increasing the morphine dose did not improve the clinical result.
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Reg Anesth Pain Med · May 1999
ReviewIntrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia.
Lipophilic opioids, especially fentanyl and sufentanil, are increasingly being administered intrathecally as adjuncts to spinal anesthesia. This review analyzes the efficacy of these opioids for subarachnoid anesthesia. ⋯ The anesthesia-enhancing properties and side-effect profile of lipophilic opioids administered intrathecally suggest significant roles for these agents as adjuncts to spinal anesthesia for obstetric and outpatient procedures.
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Reg Anesth Pain Med · May 1999
Randomized Controlled Trial Comparative Study Clinical TrialPhrenic nerve block caused by interscalene brachial plexus block: effects of digital pressure and a low volume of local anesthetic.
Interscalene brachial plexus block (ISB) is associated with phrenic block and diaphragmatic paralysis when high volumes (40-50 mL) of local anesthetic are injected. The goal of our study was to test if a low volume of local anesthetic administered while maintaining proximal digital pressure might more selectively block the brachial plexus and decrease the frequency of phrenic nerve block. ⋯ Decreasing the volume of local anesthetic and applying proximal digital pressure to the site of injection is not effective in reducing the cervical block spread and the frequency or intensity of diaphragmatic paralysis during interscalene ISB.
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Reg Anesth Pain Med · May 1999
Comparative StudyPreemptive intrathecal ketamine injection produces a long-lasting decrease in neuropathic pain behaviors in a rat model.
Ketamine is an N-Methyl-D-Aspartate (NMDA) receptor antagonist, which has been found to effectively treat somatic and neuropathic pain. This study examines the effect (on neuropathic pain) of preemptive ketamine using different routes of administration (intrathecal versus intraperitoneal). ⋯ Neuropathic pain behaviors were significantly reduced for at least 2 weeks after intrathecal ketamine was preemptively administered to animals undergoing surgery to induce neuropathic pain. The mechanism of action is thought to be prevention of spinal cord sensitization.