Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2000
Randomized Controlled Trial Clinical TrialQuality of analgesia when air versus saline is used for identification of the epidural space in the parturient.
Identification of the epidural space is often performed using the loss-of-resistance technique (LOR), commonly with air or saline. The effect of air or saline on the quality of labor epidural analgesia has not been adequately studied. ⋯ Using 0.9% saline for the LOR technique is associated with better analgesia as compared with air for labor analgesia, and this advantage should be considered when selecting the syringe contents for the LOR technique.
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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.
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Reg Anesth Pain Med · Nov 2000
Ultrasound-guided infraclavicular brachial plexus block: an alternative technique to anatomical landmark-guided approaches.
Infraclavicular brachial plexus block has been used less than other approaches because of its less uniform landmarks and the necessity of a longer needle, which increases the patient's discomfort. To overcome these drawbacks, we applied ultrasound guidance to infraclavicular approach and prospectively evaluated its feasibility and usefulness in 60 patients undergoing upper extremity surgery. ⋯ Real-time ultrasound guidance facilitates accurate infraclavicular approach to the brachial plexus. It could be used as an alternative to the landmark-guided techniques.
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Reg Anesth Pain Med · Nov 2000
Case ReportsSuccessful management of pleuritic pain with thoracic paravertebral block.
Thoracic paravertebral block (TPVB) is a unilateral analgesic technique that has been advocated in both acute and chronic thoracic and abdominal pain. Other blocks such as interpleural and epidural can be effectively used in pleuritic pain. This report illustrates that TPVB could also be effective for this kind of pain. ⋯ This case report supports the notion that, in practice, the paravertebral block could be an effective and safe alternative to relief of pleuritic pain.
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Reg Anesth Pain Med · Nov 2000
Thoracic epidural anesthesia via the modified Taylor approach in infants.
Advancement of catheters from the caudal to the thoracic level is an alternative to thoracic epidural anesthesia in infants and younger children; however, contamination of the insertion site may occur. This study examined the feasibility of the midline modified Taylor approach (L(5)-S(1)) for the advancement of epidural catheters to the thoracic level in infants. ⋯ The midline modified Taylor approach allows access to the thoracic epidural space via catheter advancement, while being below the terminus of the spinal cord and less likely to suffer contamination than the caudal approach.