Regional anesthesia and pain medicine
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Pain due to superior cluneal nerve entrapment is an infrequent cause of unilateral low back pain. Here we present a case of acute unilateral low back pain treated by superior cluneal nerve (SCN) block. ⋯ SCN is prone to entrapment where it passes through the fascia near the posterior iliac crest. Unilateral low back pain and deep tenderness radiating to the ipsilateral buttock are the clinical findings accompanying SCN entrapment. The case presented emphasizes the relief of possible SCN after limiting other etiologic causes of low back pain.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialPain on intramuscular injection of bupivacaine, ropivacaine, with and without dexamethasone.
We wished to determine which long-acting local anesthetic would produce the least pain on injection for treatment of myofascial pain disorders. We compared the pain on intramuscular injection of bupivacaine, ropivacaine, bupivacaine with dexamethasone, ropivacaine with dexamethasone, and needle placement alone. ⋯ The pain on intramuscular injection of bupivacaine is significantly more intense than with ropivacaine. The difference in the intensity of the pain on injection between bupivacaine and ropivacaine does not appear to be related to differences in pH. The results of our study have implications on the choice of the local anesthetic used in trigger point injections.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialComparison of three catheter sets for continuous spinal anesthesia in patients undergoing total hip or knee arthroplasty.
Continuous spinal anesthesia (CSA) with microcatheters may be complicated because of technical problems. In elderly patients, some of the problems may be solved by using thicker catheters. A recent invention, involving a catheter-over-needle system, may prevent leakage of cerebrospinal fluid (CSF) and may also improve the prediction of the intrathecal position of the catheter tip. ⋯ Placement of the SC catheters was unsuccessful to a high degree, and bone contact produced distortion of the tip of some of these catheters. Otherwise, the quality associated with catheterization time, anesthetic distribution, and catheter function was similar with the 3 catheters.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Clinical TrialEfficacy of simulated epinephrine-containing epidural test dose after intravenous atropine during isoflurane anesthesia in children.
A double-blind, randomized study was performed to investigate heart rate (HR) and blood pressure responses to 2 doses of intravenous (IV) epinephrine (0.5 and 0.75 microg/kg) in 61 children, ages 3 months to 12 years. ⋯ A simulated epidural test dose containing lidocaine 1 mg/kg with epinephrine 0.75 microg/kg, administered IV following atropine, may reliably increase HR to indicate unintentional injection into epidural vessels of children anesthetized with 1 MAC isoflurane.
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Clinical TrialSkin blood flow changes in response to intradermal injection of bupivacaine and levobupivacaine, assessed by laser Doppler imaging.
The vascular effects of local anesthetics are important determinants of their therapeutic activity. Drugs that vasoconstrict have the potential clinical advantages of limited systemic uptake and prolonged duration of effect. The aim of this study was to assess quantitatively the cutaneous vasoactivity of racemic bupivacaine and one of its enantiomers, levobupivacaine. ⋯ Bupivacaine and levobupivacaine both have a biphasic effect on skin microvessels. The vasoconstriction observed after 40 minutes may occur when the quantity of drug remaining at the administration site has decreased to a lower level. The continued vasodilatation caused by bupivacaine is more difficult to interpret. The results suggest that these local anesthetics cause vasodilatation at high doses and vasoconstriction at lower, subclinical doses. This hypothesis and the clinical relevance of these effects warrant further investigation.